Healthcare Provider Details

I. General information

NPI: 1689903833
Provider Name (Legal Business Name): ELIZABETH CHILDRESS WESTERN M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLOOK TERRACE
MADISON WI
53705-2254
US

IV. Provider business mailing address

2500 OVERLOOK TERRACE
MADISON WI
53705-2254
US

V. Phone/Fax

Practice location:
  • Phone: 608-280-2143
  • Fax: 608-280-7096
Mailing address:
  • Phone: 608-280-2143
  • Fax: 608-280-7096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30931
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: