Healthcare Provider Details

I. General information

NPI: 1699690891
Provider Name (Legal Business Name): DYLAN JAMES WIEST CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6790 W LAYTON AVE
GREENFIELD WI
53220-4571
US

IV. Provider business mailing address

6790 W LAYTON AVE
GREENFIELD WI
53220-4571
US

V. Phone/Fax

Practice location:
  • Phone: 414-282-3100
  • Fax: 414-282-3101
Mailing address:
  • Phone: 414-259-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: