Healthcare Provider Details

I. General information

NPI: 1366410243
Provider Name (Legal Business Name): LISA M SCHMALTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 10/24/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E WASHINGTON AVENUE APT 621
MADISON WI
53703
US

IV. Provider business mailing address

408 E WASHINGTON AVENUE APT 621
MADISON WI
53703
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-8340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number33681
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: