Organization
SOUTHERN WISCONSIN MEDICAL ASSOCIATES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID GATTUSO M.D. (PRESIDENT)
(608) 884-3417
Entity
Organization
Contact information
Practice address
92 E STATE ROAD 59, EDGERTON, WI 53534-9001
(608) 884-3417
(608) 884-9347
Mailing address
92 E STATE RD 59, EDGERTON, WI 53534-9001
(608) 884-3417
(608) 884-9347
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
218686972009
BLUE SHIELD
WI
Enumeration date
07/20/2006
Last updated
08/22/2020
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