Healthcare Provider Details

I. General information

NPI: 1427014422
Provider Name (Legal Business Name): MIDWESTERN CENTER FOR PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S PARK ST
MADISON WI
53715-1348
US

IV. Provider business mailing address

20 S PARK ST
MADISON WI
53715-1348
US

V. Phone/Fax

Practice location:
  • Phone: 608-257-2208
  • Fax:
Mailing address:
  • Phone: 608-257-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LANDGRAF
Title or Position: CRNA
Credential: CRNA
Phone: 608-257-2208