Healthcare Provider Details

I. General information

NPI: 1649250655
Provider Name (Legal Business Name): LOUIS ALAN DAINTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S WEBSTER AVE STE 300
GREEN BAY WI
54301-3528
US

IV. Provider business mailing address

1043 S QUINCY ST
GREEN BAY WI
54301-3209
US

V. Phone/Fax

Practice location:
  • Phone: 920-338-6868
  • Fax:
Mailing address:
  • Phone: 240-731-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberD0075326
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD042121
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD458373
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number75499
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number13217-320
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: