Basic Information
Provider Information | |||||||||
NPI: | 1326245390 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SADLER | ||||||||
FirstName: | DENISE | ||||||||
MiddleName: | CHANG | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CHANG | ||||||||
OtherFirstName: | DENISE | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 4131 W LOOMIS RD | ||||||||
Address2: | STE 300 | ||||||||
City: | GREENFIELD | ||||||||
State: | WI | ||||||||
PostalCode: | 532212057 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4143257246 | ||||||||
FaxNumber: | 4143253770 | ||||||||
Practice Location | |||||||||
Address1: | 4131 W LOOMIS RD | ||||||||
Address2: | STE 300 | ||||||||
City: | GREENFIELD | ||||||||
State: | WI | ||||||||
PostalCode: | 532212057 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4143257246 | ||||||||
FaxNumber: | 4143253770 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/02/2007 | ||||||||
LastUpdateDate: | 03/17/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | 50794-020 | WI | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |   |
No ID Information.