Healthcare Provider Details

I. General information

NPI: 1588583694
Provider Name (Legal Business Name): JAMES H. DVORAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 CLARMAR DR
SUN PRAIRIE WI
53590-2664
US

IV. Provider business mailing address

3526 HAWTHORN HILL DR
WAUKESHA WI
53188-2551
US

V. Phone/Fax

Practice location:
  • Phone: 414-517-7050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: