Provider Demographics
NPI:1326064528
Name:DAUPHINEE, PATRICIA K (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:K
Last Name:DAUPHINEE
Suffix:
Gender:F
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:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-0456
Mailing Address - Country:US
Mailing Address - Phone:262-654-5555
Mailing Address - Fax:262-654-9333
Practice Address - Street 1:118 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2414
Practice Address - Country:US
Practice Address - Phone:262-654-5555
Practice Address - Fax:262-654-9333
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34214-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31911200Medicaid
WI31911200Medicaid