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1841242674

NPI Code Detail

MEDICARE: DR. WENDY R MORTIMORE MD

MEDICARE: DR. WENDY R MORTIMORE 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	208000000X	Pediatrics Physician	47897	WI
2	207R00000X	Internal Medicine Physician	47897	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	039906262E	OTHER		HUMANA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841242674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDY R MORTIMORE MD

Provider Business Mailing Address
First Line	:	202 S PARK ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53715-1507
Country	:	US
Telephone Number	:	608-417-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3102 MERITER WAY
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-5833
Country	:	US
Telephone Number	:	608-417-8800
Fax Number	:

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/18/2022

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Directions to “ DR. WENDY R MORTIMORE MD” Practice Location

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