Healthcare Provider Details

I. General information

NPI: 1083843924
Provider Name (Legal Business Name): DULCE VIDA A. BALMADRID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 COUNTY HIGHWAY I
CHIPPEWA FALLS WI
54729-1423
US

IV. Provider business mailing address

1000 N OAK AVE
MARSHFIELD WI
54449-5703
US

V. Phone/Fax

Practice location:
  • Phone: 715-726-4200
  • Fax:
Mailing address:
  • Phone: 715-387-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52448
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: