Individual
WARD DIETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
8202 EXCELSIOR DR, MADISON, WI 53717-1906
(608) 883-1176
Mailing address
1265 JOHN Q HAMMONS DR, MADISON, WI 53717-1941
(608) 251-4156
(608) 257-3842
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
00224
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42908400
—
WI
Enumeration date
07/14/2006
Last updated
07/08/2007
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