Healthcare Provider Details

I. General information

NPI: 1114994571
Provider Name (Legal Business Name): MARLOWE W ELDRIDGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2548 KENDALL AVE
MADISON WI
53705-3847
US

IV. Provider business mailing address

2548 KENDALL AVE
MADISON WI
53705-3847
US

V. Phone/Fax

Practice location:
  • Phone: 608-692-8587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number40747
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: