Healthcare Provider Details

I. General information

NPI: 1336172576
Provider Name (Legal Business Name): ARNOLD BENARDETTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W WASHINGTON AVE
MADISON WI
53703-2637
US

IV. Provider business mailing address

622 ODELL ST
MADISON WI
53711-1435
US

V. Phone/Fax

Practice location:
  • Phone: 608-257-9700
  • Fax:
Mailing address:
  • Phone: 608-257-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23555
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: