Individual
DR. WENDY R MORTIMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3102 MERITER WAY, MADISON, WI 53719-5833
(608) 417-8800
Mailing address
202 S PARK ST, MADISON, WI 53715-1507
(608) 417-6000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
47897
WI
208000000X
Pediatrics Physician
47897
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
039906262E
HUMANA
—
05
—
34637600
—
WI
Enumeration date
05/17/2006
Last updated
07/18/2022
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