Provider Demographics
NPI:1376812826
Name:CAMPONESCHI, PAUL W (LMT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:W
Last Name:CAMPONESCHI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-1742
Mailing Address - Country:US
Mailing Address - Phone:608-509-8644
Mailing Address - Fax:
Practice Address - Street 1:340 S WHITNEY WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4656
Practice Address - Country:US
Practice Address - Phone:608-238-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4175-146174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist