Individual
MITZI REGALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2977 CTY HWY CX, PORTAGE, WI 53901
(608) 742-3004
(608) 742-2399
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
62647-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255339750
—
IA
01
—
421527584
TAX ID
IA
Enumeration date
08/23/2010
Last updated
12/26/2014
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