Healthcare Provider Details

I. General information

NPI: 1841636081
Provider Name (Legal Business Name): LAURA BOZZUTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S PARK ST
MADISON WI
53715-1348
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-287-2830
  • Fax:
Mailing address:
  • Phone: 608-829-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT203591
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: