Provider Demographics
NPI:1417987736
Name:CRISALLI, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:CRISALLI
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 1:1808 W BELTLINE HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2334
Mailing Address - Country:US
Mailing Address - Phone:608-250-1497
Mailing Address - Fax:608-250-1384
Practice Address - Street 1:2844 INDEX RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53713-3117
Practice Address - Country:US
Practice Address - Phone:608-229-7979
Practice Address - Fax:608-229-8110
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012657582080P0214X, 2080S0012X
WI72867-20207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1417987736Medicaid