Individual
ANGELA DAWN DIVJAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 COUNTY ROAD B, SHAWANO, WI 54166-7072
(715) 524-2161
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2008026576
MO
207Q00000X
Family Medicine Physician
Primary
57265-20
WI
Other
Enumeration date
04/17/2008
Last updated
07/16/2012
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