Provider Demographics
NPI:1669635868
Name:SCOTTBERG, MARGARET I (PA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:I
Last Name:SCOTTBERG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:I
Other - Last Name:GILGENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4425 N PORT WASHINGTON RD
Mailing Address - Street 2:CLINIC CREDENTIALING
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1082
Mailing Address - Country:US
Mailing Address - Phone:414-326-2218
Mailing Address - Fax:414-326-2208
Practice Address - Street 1:2301 N LAKE DR RM 1577
Practice Address - Street 2:COLUMBIA ST MARY'S MS CLINIC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4508
Practice Address - Country:US
Practice Address - Phone:414-291-1771
Practice Address - Fax:414-291-1781
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2298-23363AS0400X
WI2298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2298-23OtherSTATE LICENSE