Individual
MARK R. DVORAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-4990
(262) 245-2248
Mailing address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-4990
(262) 245-2248
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1149-33
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
104604-030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699750661
—
WI
01
—
430067408
RAIL ROAD MEDICARE
—
05
—
43372600
—
WI
01
—
DVORAMAR
MERCYCARE INSURANCE
WI
Enumeration date
12/13/2005
Last updated
06/13/2016
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