Provider Demographics
NPI:1164589529
Name:STAFEIL, BRIAN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ROBERT
Last Name:STAFEIL
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 1:700 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1830
Mailing Address - Country:US
Mailing Address - Phone:608-252-7458
Mailing Address - Fax:608-258-6772
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-252-7458
Practice Address - Fax:608-258-6772
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47810-20207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1164589529Medicaid
WI741501780Medicare PIN
WI60988OtherDEAN HEALTH INSURANCE