Individual
GABRIEL LUCAS TUDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 HIGHLAND AVE, MADISON, WI 53792-4902
(608) 263-1690
(608) 265-1918
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
7085-23
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2021
Last updated
05/23/2023
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