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General NPI Number Information
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NPI Number | 1053871103
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Entity Type | Individual
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Provider Name | ANDREW MARK WIDMER MD PHD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2019
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 600 HIGHLAND AVE
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City | MADISON
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State | WI
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Zip | 53792-0001
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Country | US
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Telephone | 608-263-5448
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Fax | 608-263-5448
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Provider Business Mailing Address
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Address Line | 1685 HIGHLAND AVE
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City | MADISON
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State | WI
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Zip | 53705-2281
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 85937-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 036.177455
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License Number State | IL
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