Healthcare Provider Details

I. General information

NPI: 1265845317
Provider Name (Legal Business Name): ERIC DESTRAMPE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UW HOSPITALS AND CLINICS 600 HIGHLAND AVE
MADISON WI
53792
US

IV. Provider business mailing address

UW HOSPITALS AND CLINICS 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 TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number68933
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberR-10031
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number68933
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: