MEDICARE: MARLA DAHLK PAC

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	363AM0700X	Medical Physician Assistant	542	WI

General Provider Information

NPI Number	:	1265492888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLA DAHLK PAC

Provider Business Mailing Address
First Line	:	3705 BRIGHAM AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53714-1203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3705 BRIGHAM AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53714-1203
Country	:	US
Telephone Number	:	608-320-0938
Fax Number	:

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	09/14/2016

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Directions to “ MARLA DAHLK PAC” Practice Location

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