Provider Demographics
NPI:1154870707
Name:BISHOP, TEAGAN CALAIS (PA)
Entity type:Individual
Prefix:
First Name:TEAGAN
Middle Name:CALAIS
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TEAGAN
Other - Middle Name:
Other - Last Name:GERHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-4800
Practice Address - Country:US
Practice Address - Phone:608-263-6190
Practice Address - Fax:608-263-6199
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3874363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1154870707Medicaid
WIK400331653Medicare PIN