Basic Information
| Provider Information | |||||||||
| NPI: | 1043317290 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POI | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2901 W. BELTLINE HWY. | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537134226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084435603 | ||||||||
| FaxNumber: | 6084411981 | ||||||||
| Practice Location | |||||||||
| Address1: | 3434 E. WASHINGTON AVE. | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537044155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084435550 | ||||||||
| FaxNumber: | 6084435554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 01/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 49024-20 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 34028000 | 05 | WI | MEDICAID |