Healthcare Provider Details

I. General information

NPI: 1831132000
Provider Name (Legal Business Name): DEBORAH P WUBBEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W WASHINGTON AVE
MADISON WI
53703-2996
US

IV. Provider business mailing address

202 S. PARK ST
MADISON WI
53715-1507
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-8300
  • Fax: 608-417-8301
Mailing address:
  • Phone: 608-417-5630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number45957
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: