Provider Demographics
NPI:1932174117
Name:MARTINELLI, DEAN LOUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:LOUIS
Last Name:MARTINELLI
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 1:888 THACKERAY TRAIL
Mailing Address - Street 2:SUITE 108
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066
Mailing Address - Country:US
Mailing Address - Phone:262-567-0505
Mailing Address - Fax:262-567-0778
Practice Address - Street 1:888 THACKERAY TRAIL
Practice Address - Street 2:SUITE 108
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066
Practice Address - Country:US
Practice Address - Phone:262-567-0505
Practice Address - Fax:262-567-0778
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18169207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30179100Medicaid
WI588OtherDEAN HEALTH PLAN
WI1004202OtherPHYSICIANS PLUS
WI588OtherDEAN HEALTH PLAN