Healthcare Provider Details

I. General information

NPI: 1619352226
Provider Name (Legal Business Name): COLLABORATIVE SOLUTIONS IN PSYCHIATRY, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 GRAND TETON PLZ STE 220
MADISON WI
53719-1048
US

IV. Provider business mailing address

6515 GRAND TETON PLZ STE 220
MADISON WI
53719-1048
US

V. Phone/Fax

Practice location:
  • Phone: 608-713-9898
  • Fax: 608-713-9647
Mailing address:
  • Phone: 608-713-9898
  • Fax: 608-713-9647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SOBIA KIRMANI-MOE
Title or Position: OWNER
Credential:
Phone: 608-713-9898