| Donald E. Dlouhy Llc | |
|
12728 W Hampton Ave Butler WI 53007-1602 | |
| (262) 781-8693 | |
| (262) 781-1468 |
| Full Name | Donald E. Dlouhy Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 12728 W Hampton Ave, Butler, Wisconsin |
| Authorized Official Name and Position | Donald Edward Dlouhy (OWNER) |
| Authorized Official Contact | 2627818693 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Donald E. Dlouhy Llc 12728 W Hampton Ave Butler WI 53007-1602 Ph: (262) 781-8693 | Donald E. Dlouhy Llc 12728 W Hampton Ave Butler WI 53007-1602 Ph: (262) 781-8693 |
| NPI Number | 1215177167 |
|---|---|
| Provider Enumeration Date | 03/04/2009 |
| Last Update Date | 01/06/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215177167 | NPI | - | NPPES |
| 38519900 | Medicaid | WI | |
| DE41133 | Other | WI | SPECTERA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1863-035 (Wisconsin) | Primary |