Individual
STACEY BEAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
707 S MILLS ST, MADISON, WI 53715-1849
(608) 258-6100
Mailing address
707 S MILLS ST, MADISON, WI 53715-1849
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
44496
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34338700
—
WI
Enumeration date
11/18/2005
Last updated
07/08/2007
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