MEDICARE: DENNIS A OETH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	19299	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033172796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS A OETH MD

Provider Business Mailing Address
First Line	:	8007 EXCELSIOR DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53717
Country	:	US
Telephone Number	:	608-829-5247
Fax Number	:	608-833-6932

Provider Business Practice Location Address
First Line	:	1511 PARK AVE
Second Line	:
City	:	COLUMBUS
State	:	WI
Zip	:	53925-2401
Country	:	US
Telephone Number	:	920-623-5226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/08/2007

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