Provider Demographics
NPI:1073668059
Name:BIELKE, DENNIS J (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:BIELKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5517
Mailing Address - Country:US
Mailing Address - Phone:920-336-4096
Mailing Address - Fax:920-336-8093
Practice Address - Street 1:2941 S RIDGE RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5517
Practice Address - Country:US
Practice Address - Phone:920-336-4096
Practice Address - Fax:920-336-8093
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI318732085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31706900Medicaid
WI001207201Medicare PIN
WIE96071Medicare UPIN