Individual
JODI DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2906 S 20TH ST, MILWAUKEE, WI 53215-3732
(414) 672-1353
(414) 672-4265
Mailing address
2906 S 20TH ST, MILWAUKEE, WI 53215-3732
(414) 672-1353
(414) 672-4265
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
67819
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306866066
—
WI
Enumeration date
07/19/2006
Last updated
07/21/2022
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