Healthcare Provider Details

I. General information

NPI: 1962452656
Provider Name (Legal Business Name): LALE DOUGLAS COWGILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DOUGLAS L COWGILL MD

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARK ST
MADISON WI
53715-1830
US

IV. Provider business mailing address

700 S PARK ST
MADISON WI
53715-1830
US

V. Phone/Fax

Practice location:
  • Phone: 608-260-2900
  • Fax:
Mailing address:
  • Phone: 608-260-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number27185-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: