Healthcare Provider Details

I. General information

NPI: 1861953267
Provider Name (Legal Business Name): MICHAEL DRYDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 11/03/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 WATERTOWN PLANK RD.
MILWAUKEE WI
53226
US

IV. Provider business mailing address

8701 WATERTOWN PLANK RD.
MILWAUKEE WI
53226
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-4575
  • Fax:
Mailing address:
  • Phone: 414-955-4575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number75932-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: