Provider Demographics
NPI:1881829927
Name:DALE, JANE CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:CHRISTINE
Last Name:DALE
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 1:218 S KENOSHA DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4623
Mailing Address - Country:US
Mailing Address - Phone:608-236-4254
Mailing Address - Fax:608-236-4288
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:SU 1-152
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:608-236-4254
Practice Address - Fax:608-236-4288
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31262207ZP0102X
IA26448207ZP0102X
WI43455207ZP0102X
FLME 89949207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND81553Medicare UPIN
MN220000149Medicare PIN