Healthcare Provider Details

I. General information

NPI: 1659660330
Provider Name (Legal Business Name): CHRISTINA HANOWSKY BRYNDZIA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA MELANIE HANOWSKY D.O.

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/06/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-1501
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-8049
  • Fax: 608-261-5450
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125059841
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number62425
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberR3643
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number62425
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: