Provider Demographics
NPI:1770684482
Name:BEINE, DAGMARA Z (PA-C)
Entity Type:Individual
Prefix:
First Name:DAGMARA
Middle Name:Z
Last Name:BEINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 VIOLET CT
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-1458
Mailing Address - Country:US
Mailing Address - Phone:262-752-0313
Mailing Address - Fax:
Practice Address - Street 1:8201 S HOWELL AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53135
Practice Address - Country:US
Practice Address - Phone:414-570-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1738-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIQ26816Medicare UPIN