MEDICARE: ERIC D DICHSEN 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	42225	WI

General Provider Information

NPI Number	:	1922053990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC D DICHSEN MD

Provider Business Mailing Address
First Line	:	401 W MOHAWK DR
Second Line	:
City	:	TOMAHAWK
State	:	WI
Zip	:	54487-2274
Country	:	US
Telephone Number	:	715-453-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 W MOHAWK DR
Second Line	:	SUITE 200
City	:	TOMAHAWK
State	:	WI
Zip	:	54487-2218
Country	:	US
Telephone Number	:	715-453-7200
Fax Number	:

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	11/15/2012

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