Active NPI
Philip M Marden, MD
- Pediatrics Physician
- Oconomowoc, WI
National Provider Identifier
1073659546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 14664
- Practice address
- 340 Summit Avenue
Oconomowoc, WI 53066-3747 - Phone
- (262) 567-0366
- Fax
- (262) 567-0368
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy Physician | 207KA0200X | 14664 | WI | |
| Family Medicine Physician | 207Q00000X | 14664 | WI | |
| Pediatrics Physician | 208000000X | 14664 | WI | Primary |
Addresses
Primary practice location
340 Summit Avenue
Oconomowoc, WI 53066-3747
Mailing address
340 Summit Avenue
Oconomowoc, WI 53066-3747
Phone (262) 567-0366
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1000283 | Other | PHYSICIANS PLUS INSURANCE | |
| 1200110 | Other | UNITED HEALTHCARE | |
| AS68366510001 | Other | CIGNA | |
| 718112 | Other | MANAGED HEALTH SERVICES | |
| 52D0388538 | Other | CLIA CERTIFICATE | |
| 12659 | Other | DEAN HEALTH PLAN | |
| 14664 | Other | WI | ST OF WIS MEDICAL LICENSE |
| 213688 | Other | ONE HEALTH PLAN | |
| 31212300 | Medicaid | WI | |
| 4308968 | Other | AETNA | |
| MARDENPHI | Other | MERCYCARE HEALTH PLANS | |
| 112760524654 | Other | HUMANA | |
| W003437 | Other | CHAMPUS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14664 | WI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Philip M Marden MD SC | Allergy | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354665600000",
"number": "1073659546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 SUMMIT AVENUE",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530663747",
"telephone_number": "262-567-0366",
"fax_number": "262-567-0368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 SUMMIT AVENUE",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530663747",
"telephone_number": "262-567-0366",
"fax_number": "262-567-0368"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARDEN",
"first_name": "PHILIP",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2012-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "207KA0200X",
"taxonomy_group": "",
"desc": "Allergy & Immunology, Allergy",
"state": "WI",
"license": "14664",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "14664",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "14664",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIANS PLUS INSURANCE",
"identifier": "1000283",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1200110",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "AS68366510001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANAGED HEALTH SERVICES",
"identifier": "718112",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA CERTIFICATE",
"identifier": "52D0388538",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEAN HEALTH PLAN",
"identifier": "12659",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ST OF WIS MEDICAL LICENSE",
"identifier": "14664",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ONE HEALTH PLAN",
"identifier": "213688",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31212300",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4308968",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCYCARE HEALTH PLANS",
"identifier": "MARDENPHI",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "112760524654",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "W003437",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Oconomowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.