Provider Demographics
NPI:1649329574
Name:CO, DOMINIC O (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:O
Last Name:CO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-0001
Mailing Address - Country:US
Mailing Address - Phone:608-263-6420
Mailing Address - Fax:608-833-6965
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-4874
Practice Address - Country:US
Practice Address - Phone:608-263-6420
Practice Address - Fax:608-263-0440
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI513342080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI680862573Medicare PIN
WI736012585Medicare PIN