Individual
DALE P FANNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
160 VALLEY DR, LODI, WI 53555-1464
(608) 592-3296
Mailing address
160 VALLEY DR, LODI, WI 53555-1464
(608) 592-3296
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23420
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080051114
RAILROAD MEDICARE
WI
05
—
30344600
—
WI
Enumeration date
02/22/2006
Last updated
06/07/2010
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