Provider Demographics
NPI:1902838535
Name:DICKMAN, JAMES J II (M D)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:DICKMAN
Suffix:II
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6101 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-5604
Mailing Address - Country:US
Mailing Address - Phone:715-284-5580
Mailing Address - Fax:
Practice Address - Street 1:N6101 NICHOLS RD
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-5604
Practice Address - Country:US
Practice Address - Phone:715-284-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31091400Medicaid
WI31091400Medicaid