1720474513 NPI number — BRITTANY ANNE BUHALOG M.D.

Table of content: BRITTANY ANNE BUHALOG M.D. (NPI 1720474513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720474513 NPI number — BRITTANY ANNE BUHALOG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUHALOG
Provider First Name:
BRITTANY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRENTADUE
Provider Other First Name:
BRITTANY
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720474513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1808 W BELTLINE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53713-2334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-250-1497
Provider Business Mailing Address Fax Number:
608-250-1384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
752 N HIGH POINT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53717-2236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-824-4000
Provider Business Practice Location Address Fax Number:
608-824-4945
Provider Enumeration Date:
04/08/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  5890-851 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 68131 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1720474513 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".