Healthcare Provider Details

I. General information

NPI: 1508284761
Provider Name (Legal Business Name): DR. SAMANTHA KATHERINE PABICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 ANTIETAM LN
MADISON WI
53705-2520
US

IV. Provider business mailing address

6402 ANTIETAM LN
MADISON WI
53705-2520
US

V. Phone/Fax

Practice location:
  • Phone: 708-287-9241
  • Fax:
Mailing address:
  • Phone: 708-287-9241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number65647-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number65647-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: