Provider Demographics
NPI:1275862716
Name:YAMANOUCHI, DAI (MD, PH D)
Entity Type:Individual
Prefix:
First Name:DAI
Middle Name:
Last Name:YAMANOUCHI
Suffix:
Gender:M
Credentials:MD, PH D
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-3236
Practice Address - Country:US
Practice Address - Phone:608-265-4420
Practice Address - Fax:608-265-1148
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI216-8752086S0129X
WI4-8762086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery