Healthcare Provider Details

I. General information

NPI: 1316070659
Provider Name (Legal Business Name): MADISON BIRTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 FRANK LLOYD WRIGHT AVE SUITE 103
MIDDLETON WI
53562-1753
US

IV. Provider business mailing address

6720 FRANK LLOYD WRIGHT AVE SUITE 103
MIDDLETON WI
53562-1753
US

V. Phone/Fax

Practice location:
  • Phone: 608-821-0123
  • Fax: 608-821-0124
Mailing address:
  • Phone: 608-821-0123
  • Fax: 608-821-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: MRS. ASZANI KUNKLER
Title or Position: DIRECTOR
Credential: CNM, MSN
Phone: 608-821-0123