Individual
DANIEL SCOTT DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3750
(414) 259-9290
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3750
(414) 259-9290
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01075295A
IN
2085R0202X
Diagnostic Radiology Physician
4301097006
MI
2085R0202X
Diagnostic Radiology Physician
Primary
67497
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821301946
—
WI
Enumeration date
07/18/2010
Last updated
07/21/2022
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