Provider Demographics
NPI:1336104421
Name:DICKMEYER, KARLA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:JEAN
Last Name:DICKMEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KARLA
Other - Middle Name:JEAN
Other - Last Name:KONIECZKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5801 RESEARCH PARK BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-6002
Mailing Address - Country:US
Mailing Address - Phone:608-729-6300
Mailing Address - Fax:608-729-1099
Practice Address - Street 1:5801 RESEARCH PARK BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-6002
Practice Address - Country:US
Practice Address - Phone:608-729-6300
Practice Address - Fax:608-729-1099
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39842-020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32438600Medicaid
WIG75755Medicare UPIN
WI153950027Medicare ID - Type Unspecified