Organization
DAVID VAN DYKE MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE C NOTH (CLINIC DIRECTOR)
(608) 637-2511
Entity
Organization
Contact information
Practice address
122 W SOUTH ST, VIROQUA, WI 54665-0187
(608) 637-2511
(608) 637-7921
Mailing address
PO BOX 187, 122 W SOUTH ST, VIROQUA, WI 54665-0187
(608) 637-2511
(608) 637-7921
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
19557020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30101600
—
WI
Enumeration date
02/01/2007
Last updated
08/22/2020
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