Healthcare Provider Details

I. General information

NPI: 1205671682
Provider Name (Legal Business Name): RYAN HEUMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date: 04/07/2026
Reactivation Date: 05/01/2026

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-0001
US

IV. Provider business mailing address

600 HIGHLAND AVE
MADISON WI
53792-0001
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-6400
  • Fax:
Mailing address:
  • Phone: 608-263-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number102348
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: