Healthcare Provider Details

I. General information

NPI: 1669437778
Provider Name (Legal Business Name): SUSAN E SKOCHELAK MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 SCIENCE DRIVE
MADISON WI
53711
US

IV. Provider business mailing address

8007 EXCELSIOR DRIVE
MADISON WI
53717
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-8400
  • Fax: 608-265-8410
Mailing address:
  • Phone: 608-829-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28083
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: