Provider Demographics
NPI:1760055578
Name:UTZIG, JAMISON CLYDE DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JAMISON
Middle Name:CLYDE DAVID
Last Name:UTZIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMISON
Other - Middle Name:CLYDE DAVID
Other - Last Name:UTZIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:849 KELLOGG AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-2808
Mailing Address - Country:US
Mailing Address - Phone:608-755-7960
Mailing Address - Fax:608-755-7873
Practice Address - Street 1:3524 E MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-1626
Practice Address - Country:US
Practice Address - Phone:608-756-7100
Practice Address - Fax:608-756-7225
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8828-851390200000X
WI81756-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program