Healthcare Provider Details

I. General information

NPI: 1053763763
Provider Name (Legal Business Name): GAIL SERIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5513 ODANA RD
MADISON WI
53719-1205
US

IV. Provider business mailing address

2714 TOWER RD
MC FARLAND WI
53558-9273
US

V. Phone/Fax

Practice location:
  • Phone: 608-256-6440
  • Fax:
Mailing address:
  • Phone: 608-256-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: