Provider Demographics
NPI:1205837408
Name:DICKLIN, MARC E (PA -C)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:E
Last Name:DICKLIN
Suffix:
Gender:M
Credentials:PA -C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1500 ASSOCIATES DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2201
Mailing Address - Country:US
Mailing Address - Phone:563-584-4100
Mailing Address - Fax:563-584-4110
Practice Address - Street 1:1000 LANGWORTHY ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7313
Practice Address - Country:US
Practice Address - Phone:563-584-3455
Practice Address - Fax:563-584-3314
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA001351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK12770Medicare UPIN
ILK12770Medicare UPIN