Healthcare Provider Details

I. General information

NPI: 1184845133
Provider Name (Legal Business Name): MEGHAN GALVIN LUBNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E3 342 CLINICAL SCIENCES CTR 600 HIGHLAND AVE
MADISON WI
53792-0001
US

IV. Provider business mailing address

E3 342 CLINICAL SCIENCES CTR 600 HIGHLAND AVE
MADISON WI
53792-0001
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-9028
  • Fax:
Mailing address:
  • Phone: 608-263-9028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number51557-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: