MEDICARE: DENNIS WORTHINGTON 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	207VM0101X	Maternal & Fetal Medicine Physician	23370	WI
2	207V00000X	Obstetrics & Gynecology Physician	23370	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245224864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS WORTHINGTON MD

Provider Business Mailing Address
First Line	:	201 N MAYFAIR ROAD
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-4216
Country	:	US
Telephone Number	:	414-259-7480
Fax Number	:	414-259-7481

Provider Business Practice Location Address
First Line	:	201 N MAYFAIR ROAD
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-4216
Country	:	US
Telephone Number	:	414-259-7480
Fax Number	:	414-259-7481

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	02/06/2012

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Directions to “ DENNIS WORTHINGTON MD” Practice Location

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