Provider Demographics
NPI:1811494230
Name:DYRUD, PAUL AMOS (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:AMOS
Last Name:DYRUD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:MEDICAL COLLEGE OF WISCONSIN AFFILIATED HOSPITALS, INC.
Mailing Address - Street 2:8701 WATERTOWN PLANK ROAD
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL COLLEGE OF WISCONSIN AFFILIATED HOSPITALS, INC.
Practice Address - Street 2:8701 WATERTOWN PLANK ROAD
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-955-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI72469-20208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100096281Medicaid