Physician Compare National (NPI:1073659546)

HEALTHCARE PROVIDER: PHILIP M MARDEN MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1073659546
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7012048614
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100810000484
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MARDEN
	Individual professional last name
Provider First Name	PHILIP
	Individual professional first name
Provider Middle Name	MANUEL
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1962
	Individual professional's medical school graduation year
Primary Specialty	PEDIATRIC MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	ALLERGY/IMMUNOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	FAMILY MEDICINE
	Second secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	ALLERGY/IMMUNOLOGY, FAMILY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	340 SUMMIT AVE
	Group Practice or individual's line 1 address
City	OCONOMOWOC
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	530663747
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y