Healthcare Provider Details

I. General information

NPI: 1376502468
Provider Name (Legal Business Name): WENDY S COLEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 CHADBOURNE AVE
MADISON WI
53726-3927
US

IV. Provider business mailing address

2115 CHADBOURNE AVE
MADISON WI
53726-3927
US

V. Phone/Fax

Practice location:
  • Phone: 608-238-9258
  • Fax:
Mailing address:
  • Phone: 608-238-9258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19403
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: