PHILIP M MARDEN MD SC (NPI# 1700996576) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700996576 |
| Entity Type | Organization |
| Organization Name | PHILIP M MARDEN MD SC |
| Practice Address |
340 Summit Avenue Oconomowoc WI 53066-3747 |
| Practice Telephone | 2625670366 |
| Practice Fax Number | 2625670368 |
| Mailing Telephone | 2625670366 |
| Mailing Fax Number | 2625670368 |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-12-06 |
| Authorized Official Name | PHILIP MANUEL MARDEN (PRESIDENT) |
| Authorized Official Telephone | 2626670366 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207KA0200X |
Allergy & Immunology Specialization: Allergy |
14664 | WI | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 14664 | WI | Allopathic & Osteopathic Physicians |
| Y | 208000000X | Pediatrics | 14664 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CIGNA | AS68366510001 | 01 | |
| UNITED HEALTH CARE | 1200110 | 01 | |
| DEAN HEALTH PLAN | 12659 | 01 | |
| ONE HEALTH PLAN | 213688 | 01 | |
| AETNA | 4308968 | 01 | |
| HUMANA | 112760524654 | 01 | |
| MANAGED HEALTH SERVICES | 718112 | 01 | |
| CHAMPUS | W003437 | 01 | |
| MEDICAL LICENSE | 14664 | 01 | |
| WI | 31212300 | 05 | |
| MERCYCARE HEALTH PLANS | MARDENPHI | 01 | |
| CLIA CERTIFICATE | 52D0388538 | 01 | |
| PHYSICIANS PLUS INSURANCE | 1000283 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073652525 | Philip M Marden Md Sc | Allergy & Immunology | 123 Hospital Drive, Suite 212, Watertown, WI 53098-3336 | 2007-02-05 |
| Street Address |
340 SUMMIT AVENUE |
| City | OCONOMOWOC |
| State | WI |
| Zip Code | 53066-3747 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073659546 | Philip M Marden | Allergy & Immunology | 340 Summit Avenue, Oconomowoc, WI 53066-3747 | 2007-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376109082 | Sharon Legwinski | Occupational Therapist | 2195 N. Summit Way, Oconomowoc, WI 53066 | 2019-05-17 |
| 1033676390 | Paladina Health, LLC | Family Medicine | Paladina Health Oconomowoc Sentry Equipment Circle, 966 Blue Ribbon Circle N, Oconomowoc, WI 53066 | 2019-02-22 |
| 1689145500 | Oconomowoc Developmental Training Center of Wisconsin LLC | Residential Treatment Facility, Emotionally Disturbed Children | 36100 Genesee Lake School, Oconomowoc, WI 53066 | 2018-12-17 |
| 1649748203 | Ginny Dacquisto | Dietitian, Registered | 1134 Lily Rd, Oconomowoc, WI 53066 | 2018-11-12 |
| 1174000764 | Aimee M Metzger | Social Worker | 405 E Forest St Ste 113, Oconomowoc, WI 53066 | 2018-07-26 |
| 1023482569 | Forefront Dermatology, S.c. | Dermatology | 1320 Pabst Farms Cir, Suite 180, Oconomowoc, WI 53066 | 2015-11-20 |
| 1962890475 | Monica Rodriguez | Counselor | 405 East Forest Street, Suite 119, Oconomowoc, WI 53066 | 2015-01-06 |
| 1518384643 | Kimberley Bevan | Pharmacist | 1284 East Summit Avenue, Suite 100, Oconomowoc, WI 53066 | 2014-03-26 |
| 1699098905 | Heidi Eckroth Nunnemacher | Counselor | 35315 Genesee Lake Road, Oconomowoc, WI 53066 | 2010-03-02 |
| 1669705240 | Oconomowoc Development Training Center Ll | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3222 N. Silver Cedar Rd., Oconomowoc, WI 53066 | 2009-09-14 |
| Find all providers in zip 53066 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588706998 | Prohealth Care Medical Associates Inc | Pediatrics | 1260b Brown St, Oconomowoc, WI 53066-2491 | 2007-02-13 |
| 1326032624 | Kimberly J Kastner | Pediatrics | 970 S Silver Lake St Ste 102, Oconomowoc, WI 53066-3802 | 2005-09-01 |
| 1326124496 | Justin Leo Schilz | Pediatrics | 970 S Silver Lake St Ste 102, Oconomowoc, WI 53066 | 2006-10-31 |
| 1336256445 | David O Ulery | Pediatrics | 915 Summit Ave, Oconomowoc, WI 53066-3994 | 2006-08-24 |
| 1265549125 | Mark R Wessling | Pediatrics | 915 Summit Ave, Oconomowoc, WI 53066-3994 | 2006-08-24 |
| 1295842730 | Robert W Krieger | Pediatrics | 915 Summit Ave, Oconomowoc, WI 53066-3994 | 2006-08-23 |
| 1093822587 | Michelle M Mielke | Pediatrics | 915 Summit Ave, Oconomowoc, WI 53066-3994 | 2006-08-23 |
| 1801849963 | Lake Country Pediatrics Sc | Pediatrics | 970 S Silver Lake St, Ste. 102, Oconomowoc, WI 53066-3802 | 2006-05-18 |
| 1619940947 | Gregory Michael Moyer | Pediatrics | 970 S Silver Lake St, Ste. 102, Oconomowoc, WI 53066-3802 | 2006-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437767977 | St Francs Pediatrics | Pediatrics | 3201 S 16th St Ste 100, Milwaukee, WI 53215-4579 | 2020-07-21 |
| 1780155275 | Children's Health System, Inc. | Pediatrics | 6809 122nd Avenue, Kenosha, WI 54342-7335 | 2018-12-10 |
| 1467972950 | Cameron Trammell Shamsi Kasmai | Pediatrics | 9000 W Wisconsin Ave # Ms 681, Milwaukee, WI 53226-4874 | 2017-06-26 |
| 1669903993 | Kristin Zorn | Pediatrics | 8701 W Watertown Plank Rd # Mfrc3018, Milwaukee, WI 53226-3548 | 2017-03-27 |
| 1487195822 | Jane A Rivas | Pediatrics | 9000 W Wisconsin Ave # C550, Milwaukee, WI 53226-4874 | 2017-03-18 |
| 1467996991 | Children's Medical Group | Pediatrics | N168w22730 Prairie View Lane, Jackson, WI 53037 | 2016-12-19 |
| 1366997496 | Ujuchukwu Chizurum Okpechi | Pediatrics | 2700 W 9th Ave Ste 211, Oshkosh, WI 54904-7865 | 2016-08-18 |
| 1396193454 | Helen Gerseny Waterman | Pediatrics | 123 E Mifflin St Apt 200, Madison, WI 53703-2810 | 2016-05-31 |
| 1972951127 | Hillary Herman | Pediatrics | 1506 S Oneida St Fl 5, Appleton, WI 54915-1305 | 2016-05-27 |
| 1811350416 | Brittney Allison Krueger | Pediatrics | 4855 S Moorland Rd Ste 150, New Berlin, WI 53151-7495 | 2016-03-31 |
| Find all providers with the same taxonomy | ||||
| City | OCONOMOWOC |
| Zip Code | 53066 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.