Provider Demographics
NPI:1962452656
Name:COWGILL, LALE DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:LALE
Middle Name:DOUGLAS
Last Name:COWGILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:L
Other - Last Name:COWGILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:700 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1830
Mailing Address - Country:US
Mailing Address - Phone:608-260-2900
Mailing Address - Fax:
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-260-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27185-202086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30679000Medicaid
WI30679000Medicaid
WI010474150Medicare PIN
B84781Medicare UPIN
WI1526OtherDEAN HEALTH INSURANCE