Healthcare Provider Details

I. General information

NPI: 1154422640
Provider Name (Legal Business Name): JENNIFER LOUISE PENZOTTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLOOK TER
MADISON WI
53705-2254
US

IV. Provider business mailing address

2500 OVERLOOK TER
MADISON WI
53705-2254
US

V. Phone/Fax

Practice location:
  • Phone: 608-256-1901
  • Fax: 608-280-7020
Mailing address:
  • Phone: 608-256-1901
  • Fax: 608-280-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number49274
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: