Provider Demographics
NPI:1205851284
Name:ANDERSON, DAWN J (DPM)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2646
Mailing Address - Country:US
Mailing Address - Phone:715-675-2321
Mailing Address - Fax:715-675-6530
Practice Address - Street 1:1445 MERRILL AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2646
Practice Address - Country:US
Practice Address - Phone:715-675-2321
Practice Address - Fax:715-675-6530
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI817-25213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI007445003OtherMEDICARE PTAN
WI43230600Medicaid
WI43230600Medicaid