Healthcare Provider Details

I. General information

NPI: 1053772616
Provider Name (Legal Business Name): DAVID BELL PHD, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OBSERVATORY DR
MADISON WI
53706-1121
US

IV. Provider business mailing address

2000 OBSERVATORY DR
MADISON WI
53706-1121
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-2891
  • Fax:
Mailing address:
  • Phone: 608-265-2891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1232
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: