Healthcare Provider Details

I. General information

NPI: 1952220311
Provider Name (Legal Business Name): LAMIN BOJANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 FOREST RUN WAY
MADISON WI
53704-7756
US

IV. Provider business mailing address

3118 FOREST RUN WAY
MADISON WI
53704-7756
US

V. Phone/Fax

Practice location:
  • Phone: 608-721-9711
  • Fax:
Mailing address:
  • Phone: 608-721-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberB081700
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: