Individual provider Active NPI

Fiatsogbe Setutsi Dzuali

  • Dermatology Physician
  • Madison, WI
National Provider Identifier
1922637644
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
85958-20 Issued in WI
Practice address
4621 Eastpark Blvd
Madison, WI 53718-2000
Phone
(608) 914-0300
NPI assigned
Apr 4, 2020
Last updated
Sep 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 85958-20 WI Primary

Addresses

Primary practice location

4621 Eastpark Blvd
Madison, WI 53718-2000

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531

Other practice location 1

451 Junction Rd
Madison, WI 53717-2656
Phone (608) 263-6226

Other practice location 2

2799 W Grand Blvd
Detroit, MI 48202-2689
Phone (313) 916-2889

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251016004223 WI Practitioner - Dermatology 2668897414 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Harvard Medical School, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4621 Eastpark Blvd
Madison, WI 53718-2000
Phone (608) 914-0100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision14
Removal of skin lesions38
Removal of skin cancer140
Skin biopsy20

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
85958-20WIMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Wisconsin Medical Foundation, Inc CurrentSince Oct 1, 2025 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Oct 1, 2025 Accepting new patients
University of Wisconsin Medical Foundation Inc Past Accepting new patients

Locations

451 Junction Rd
Madison, WI 53717
Phone (608) 263-5010

4621 Eastpark Blvd
Madison, WI 53718
Phone (608) 914-0100

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

7974 Uw Health Ct
Middleton, WI 53562
Phone (608) 829-5270

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1922637644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4621 EASTPARK BLVD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537182000",
            "telephone_number": "608-914-0300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "451 Junction Rd",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537172656",
            "country_code": "US",
            "telephone_number": "608-263-6226",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2799 W Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482022689",
            "country_code": "US",
            "telephone_number": "313-916-2889",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DZUALI",
        "first_name": "FIATSOGBE",
        "middle_name": "SETUTSI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-04",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WI",
            "license": "85958-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.