Provider Demographics
NPI:1003075573
Name:BIRNBAUM, MARVIN LYLE (MD)
Entity Type:Individual
Prefix:PROF
First Name:MARVIN
Middle Name:LYLE
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2167
Mailing Address - Country:US
Mailing Address - Phone:608-263-9641
Mailing Address - Fax:608-265-4429
Practice Address - Street 1:3330 UNIVERSITY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2167
Practice Address - Country:US
Practice Address - Phone:608-263-9641
Practice Address - Fax:608-265-4429
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14237020207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine