Healthcare Provider Details

I. General information

NPI: 1124949557
Provider Name (Legal Business Name): ILEANA VASILIKI BALTOGIANNI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UW HEALTH - GME 749 UNIVERSITY ROW STE 200 MADISON, WI
MADISON WI
53705
US

IV. Provider business mailing address

UW HEALTH - GME 749 UNIVERSITY ROW STE 200 MADISON, WI
MADISON WI
53705
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-6400
  • Fax:
Mailing address:
  • Phone: 608-263-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number102459851
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: