Provider Demographics
NPI:1073665923
Name:DRS. DAHLGREN & NEITZKE, INC.
Entity Type:Organization
Organization Name:DRS. DAHLGREN & NEITZKE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:DAHLGREN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:414-453-1010
Mailing Address - Street 1:7311 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4730
Mailing Address - Country:US
Mailing Address - Phone:414-453-1010
Mailing Address - Fax:
Practice Address - Street 1:7311 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4730
Practice Address - Country:US
Practice Address - Phone:414-453-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38410500Medicaid
WI0176070001Medicare NSC
WI87709Medicare PIN