Healthcare Provider Details

I. General information

NPI: 1518934157
Provider Name (Legal Business Name): DIANNE LYNN ZWICKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215
US

IV. Provider business mailing address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

V. Phone/Fax

Practice location:
  • Phone: 414-646-2438
  • Fax: 414-649-3278
Mailing address:
  • Phone: 414-646-2438
  • Fax: 414-649-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number25815
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: