Healthcare Provider Details

I. General information

NPI: 1407816358
Provider Name (Legal Business Name): NEONATAL RESOURCES OF WISCONSIN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARK ST
MADISON WI
53715-1830
US

IV. Provider business mailing address

700 S PARK ST
MADISON WI
53715-1830
US

V. Phone/Fax

Practice location:
  • Phone: 608-258-6831
  • Fax: 608-826-2710
Mailing address:
  • Phone: 608-258-6831
  • Fax: 608-826-2710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMIP KOTHARI
Title or Position: PRESIDENT
Credential: MD
Phone: 608-251-6831