Provider Demographics
NPI:1740867332
Name:M DIKA DERMATOLOGY
Entity type:Organization
Organization Name:M DIKA DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARTHE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-412-9305
Mailing Address - Street 1:1050 MILWAUKEE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1380
Mailing Address - Country:US
Mailing Address - Phone:414-433-7692
Mailing Address - Fax:906-208-6538
Practice Address - Street 1:1050 MILWAUKEE AVE STE 101
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1380
Practice Address - Country:US
Practice Address - Phone:414-433-7692
Practice Address - Fax:906-208-6538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-28
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty