Individual
DR. MARIE A DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1100 GATEWAY CT, WEST BEND, WI 53095-8539
(262) 335-8600
Mailing address
1100 GATEWAY CT, WEST BEND, WI 53095-8539
(262) 335-8600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
68577
WI
208M00000X
Hospitalist Physician
Primary
68577
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100074618
—
WI
Enumeration date
08/09/2006
Last updated
04/02/2020
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