Provider Demographics
NPI:1649220229
Name:MARIANO, DIONISIO JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:DIONISIO
Middle Name:JAMES
Last Name:MARIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:D
Other - Middle Name:JAMES
Other - Last Name:MARIANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:BIN 88040
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53288-0040
Mailing Address - Country:US
Mailing Address - Phone:920-886-9380
Mailing Address - Fax:920-886-9381
Practice Address - Street 1:5045 W GRANDE MARKET DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8517
Practice Address - Country:US
Practice Address - Phone:920-886-9380
Practice Address - Fax:920-886-9381
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33293-020207RC0001X, 207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31839200Medicaid
WI0010Medicare ID - Type Unspecified
WIE04870Medicare UPIN