Healthcare Provider Details

I. General information

NPI: 1588780134
Provider Name (Legal Business Name): JOHN BISGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-0001
US

IV. Provider business mailing address

1303 AZALEA CT STE C
MYRTLE BEACH SC
29577-5765
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-8340
  • Fax: 608-263-0682
Mailing address:
  • Phone: 843-692-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number63236
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: