Healthcare Provider Details

I. General information

NPI: 1881156909
Provider Name (Legal Business Name): PAIGE ELIZABETH CONDIT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 PRISCILLA LN
MADISON WI
53705-5216
US

IV. Provider business mailing address

3918 PRISCILLA LN
MADISON WI
53705-5216
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-6236
  • Fax:
Mailing address:
  • Phone: 616-481-9914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74714-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number74714-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: