Provider Demographics
NPI:1295230407
Name:LIVELY, MORGAN (DO)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:LIVELY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:LAFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-1801
Mailing Address - Country:US
Mailing Address - Phone:608-877-2777
Mailing Address - Fax:608-877-2774
Practice Address - Street 1:225 CHURCH ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1801
Practice Address - Country:US
Practice Address - Phone:608-877-2777
Practice Address - Fax:608-877-2774
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72523-21207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1295230407Medicaid