Organization
PHILIP M MARDEN MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP MANUEL MARDEN MD (PRESIDENT)
(262) 667-0366
Entity
Organization
Contact information
Practice address
340 SUMMIT AVENUE, OCONOMOWOC, WI 53066-3747
(262) 567-0366
(262) 567-0368
Mailing address
340 SUMMIT AVENUE, OCONOMOWOC, WI 53066-3747
(262) 567-0366
(262) 567-0368
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
14664
WI
207Q00000X
Family Medicine Physician
14664
WI
208000000X
Pediatrics Physician
Primary
14664
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000283
PHYSICIANS PLUS INSURANCE
—
01
—
112760524654
HUMANA
—
01
—
1200110
UNITED HEALTH CARE
—
01
—
12659
DEAN HEALTH PLAN
—
01
—
14664
MEDICAL LICENSE
—
01
—
213688
ONE HEALTH PLAN
—
05
—
31212300
—
WI
01
—
4308968
AETNA
—
01
—
52D0388538
CLIA CERTIFICATE
—
01
—
718112
MANAGED HEALTH SERVICES
—
01
—
AS68366510001
CIGNA
—
01
—
MARDENPHI
MERCYCARE HEALTH PLANS
—
01
—
W003437
CHAMPUS
—
Enumeration date
08/30/2006
Last updated
12/06/2012
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