Individual
DR. DOROTHY JILL MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
251 E COTTAGE GROVE RD, COTTAGE GROVE, WI 53527-9619
(608) 839-3515
(608) 839-3541
Mailing address
251 E COTTAGE GROVE RD, COTTAGE GROVE, WI 53527-9619
(608) 839-3515
(608) 839-3541
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
49462-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151150020
MEDICARE PTAN
WI
05
—
34734300
—
WI
Enumeration date
06/07/2006
Last updated
11/02/2020
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