Individual
DR. DANIEL LEE ICENOGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
507 S MAIN ST, VIROQUA, WI 54665-2059
(608) 637-4260
(608) 637-7492
Mailing address
S7563 RILEY RD, READSTOWN, WI 54652-8030
(608) 637-4260
(608) 637-7492
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29039
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3136880
—
WI
Enumeration date
05/10/2006
Last updated
02/18/2013
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