Individual
KRISTIAN DIPERSIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 REGENT ST STE 302, MADISON, WI 53715-2634
(608) 441-3290
Mailing address
810 EMERALD ST # 1, MADISON, WI 53715-1612
(608) 359-5612
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
11246-146
WI
Other
Enumeration date
06/01/2015
Last updated
06/01/2015
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