Healthcare Provider Details

I. General information

NPI: 1487023297
Provider Name (Legal Business Name): SHARE THE HEALTH FREE GYNECOLOGY CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 RESEARCH PARK BLVD SUITE 400
MADISON WI
53719-6002
US

IV. Provider business mailing address

5801 RESEARCH PARK BLVD SUITE 400
MADISON WI
53719-6002
US

V. Phone/Fax

Practice location:
  • Phone: 608-729-6395
  • Fax:
Mailing address:
  • Phone: 608-729-6395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: BILL DICKMEYER
Title or Position: TREASURER
Credential:
Phone: 608-729-6395