Healthcare Provider Details

I. General information

NPI: 1851368013
Provider Name (Legal Business Name): RICHARD M PAULI MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N YELLOWSTONE DR
MADISON WI
53705-2450
US

IV. Provider business mailing address

202 N YELLOWSTONE DR
MADISON WI
53705-2450
US

V. Phone/Fax

Practice location:
  • Phone: 608-833-3663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number23489
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: