Provider Demographics
NPI:1255383394
Name:KRESGE, DEAN G (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:G
Last Name:KRESGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CHURCH ST
Mailing Address - Street 2:DEAN MEDICAL CENTER
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-1801
Mailing Address - Country:US
Mailing Address - Phone:608-877-2700
Mailing Address - Fax:608-877-2774
Practice Address - Street 1:225 CHURCH ST
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1801
Practice Address - Country:US
Practice Address - Phone:608-877-2700
Practice Address - Fax:608-877-2774
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25971-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30755800Medicaid
WI474OtherDEAN HEALTH INSURANCE
WI474OtherDEAN HEALTH INSURANCE
WI020554340Medicare PIN
WI003674150Medicare PIN
WI080044485Medicare PIN