Provider Demographics
NPI:1043604424
Name:DIKA, MARTHE NGONGANG (MD)
Entity Type:Individual
Prefix:
First Name:MARTHE
Middle Name:NGONGANG
Last Name:DIKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHE
Other - Middle Name:CEME
Other - Last Name:NGONGANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1050 MILWAUKEE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1380
Mailing Address - Country:US
Mailing Address - Phone:414-433-7692
Mailing Address - Fax:906-208-6538
Practice Address - Street 1:1050 MILWAUKEE AVE STE 101
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1380
Practice Address - Country:US
Practice Address - Phone:414-433-7692
Practice Address - Fax:906-208-6538
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-44476207N00000X
WI71553-20207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology