Individual
DILLON VIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2817 NEW PINERY RD, PORTAGE, WI 53901-9240
(608) 742-4131
Mailing address
2817 NEW PINERY RD, PORTAGE, WI 53901-9240
(608) 742-4131
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4984-23
WI
Other
Enumeration date
05/06/2019
Last updated
02/28/2020
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