Provider Demographics
NPI:1225618838
Name:SAYRE, MIKKO NEVIN (MD)
Entity Type:Individual
Prefix:
First Name:MIKKO
Middle Name:NEVIN
Last Name:SAYRE
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 1:800 UNIVERSITY BAY DR STE 310
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2299
Mailing Address - Country:US
Mailing Address - Phone:608-263-8241
Mailing Address - Fax:
Practice Address - Street 1:800 UNIVERSITY BAY DR STE 310
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2299
Practice Address - Country:US
Practice Address - Phone:608-263-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI81339-20207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program