Healthcare Provider Details

I. General information

NPI: 1568040988
Provider Name (Legal Business Name): HAROUTIUN HAMZOIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 05/11/2025
Certification Date: 05/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 UNIVERSITY ROW STE 200
MADISON WI
53705-1465
US

IV. Provider business mailing address

749 UNIVERSITY ROW STE 200
MADISON WI
53705-1465
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-0572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number8561620
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: