Provider Demographics
NPI:1851300362
Name:PRINCE, DARRYL M (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:M
Last Name:PRINCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1111 DELAFIELD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3402
Mailing Address - Country:US
Mailing Address - Phone:262-542-9503
Mailing Address - Fax:262-542-8447
Practice Address - Street 1:1111 DELAFIELD ST STE 105
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3402
Practice Address - Country:US
Practice Address - Phone:262-542-9503
Practice Address - Fax:262-542-8447
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI37580-0202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIG25240Medicare UPIN