Provider Demographics
NPI:1457323099
Name:DOROW, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:DOROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:N17W24100 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:2085 N CALHOUN RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5003
Practice Address - Country:US
Practice Address - Phone:262-928-7100
Practice Address - Fax:262-513-7111
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI23752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30437200Medicaid
WI003768300Medicare PIN
WI30437200Medicaid
WIB52490Medicare UPIN