Provider Demographics
NPI:1467617886
Name:MADISON HAIR TRANSPLANT CLINIC SC
Entity Type:Organization
Organization Name:MADISON HAIR TRANSPLANT CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GENCHEFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:608-241-8848
Mailing Address - Street 1:2830 DRYDEN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3084
Mailing Address - Country:US
Mailing Address - Phone:608-241-8848
Mailing Address - Fax:608-241-8188
Practice Address - Street 1:2830 DRYDEN DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3084
Practice Address - Country:US
Practice Address - Phone:608-241-8848
Practice Address - Fax:608-241-8188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24092-021208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB84876Medicare UPIN