Provider Demographics
NPI:1346217916
Name:DEHNER, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:DEHNER
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 1:715 W MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-1564
Mailing Address - Country:US
Mailing Address - Phone:712-213-0109
Mailing Address - Fax:712-213-0186
Practice Address - Street 1:715 W MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-1564
Practice Address - Country:US
Practice Address - Phone:712-213-0109
Practice Address - Fax:712-213-0186
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32536100Medicaid
WIA01518Medicare UPIN
WI32536100Medicaid