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General NPI Number Information
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NPI Number | 1841421872
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Entity Type | Individual
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Provider Name | BENJAMIN TODD GILLESPIE DO
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Gender | Male
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Dates
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Enumeration Date | 08/08/2009
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 6630 UNIVERSITY AVE
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City | MIDDLETON
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State | WI
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Zip | 53562-3036
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Country | US
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Telephone | 608-263-6540
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Fax | 608-263-5011
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Provider Business Mailing Address
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Address Line | 7974 UW HEALTH COURT
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City | MIDDLETON
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State | WI
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Zip | 53562-5356
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Country | US
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Telephone | 608-829-5485
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 67242-21
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License Number State | WI
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