MEDICARE: DR. SAVANAH DIOR GISRIEL MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZC0006X	Clinical Pathology Physician	84018	WI
2	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	84018-20	WI
3	207ZH0000X	Hematology (Pathology) Physician	84018-20	WI

General Provider Information

NPI Number	:	1538724406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAVANAH DIOR GISRIEL MD, MPH

Provider Business Mailing Address
First Line	:	7974 UW HEALTH CT
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-5531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 HIGHLAND AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53792-3220
Country	:	US
Telephone Number	:	608-263-8443
Fax Number	:	608-262-7174

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	04/14/2025

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