MEDICARE: DEBORAH B EHRENTHAL MD

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	207V00000X	Obstetrics & Gynecology Physician	62116	WI

General Provider Information

NPI Number	:	1730166273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH B EHRENTHAL MD

Provider Business Mailing Address
First Line	:	360 W WASHINGTON AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53703-2755
Country	:	US
Telephone Number	:	484-459-2703
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 W WASHINGTON AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53703-2755
Country	:	US
Telephone Number	:	484-459-2703
Fax Number	:

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	09/17/2021

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