Provider Demographics
NPI:1518934157
Name:ZWICKE, DIANNE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:LYNN
Last Name:ZWICKE
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 1:2900 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4330
Mailing Address - Country:US
Mailing Address - Phone:414-646-2438
Mailing Address - Fax:414-649-3278
Practice Address - Street 1:2900 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-646-2438
Practice Address - Fax:414-649-3278
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25815207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30603400Medicaid
WI30603400Medicaid
003146515Medicare PIN
B57859Medicare UPIN
003140245Medicare PIN
003104130Medicare PIN
003154475Medicare PIN