Healthcare Provider Details

I. General information

NPI: 1134338841
Provider Name (Legal Business Name): MICHAEL ANTHONY DIDION DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 S 20TH ST SUITE 150
MILWAUKEE WI
53215-4941
US

IV. Provider business mailing address

5916 NORTH GREEN BAY AVE
MILWAUKEE WI
53209-3810
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2100
  • Fax: 414-384-2700
Mailing address:
  • Phone: 262-242-6105
  • Fax: 262-242-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number19384
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: