Provider Demographics
NPI:1184758237
Name:MCFADDEN, DENNIS S (DO)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:S
Last Name:MCFADDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W10033 PARKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-9314
Mailing Address - Country:US
Mailing Address - Phone:715-610-5209
Mailing Address - Fax:715-610-5209
Practice Address - Street 1:W10033 PARKSIDE LN
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-9314
Practice Address - Country:US
Practice Address - Phone:715-610-5209
Practice Address - Fax:715-610-5209
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54861-21207V00000X
AKO-8258207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200125950AMedicaid
OK200125950AMedicaid