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General NPI Number Information
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NPI Number | 1295324929
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Entity Type | Individual
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Provider Name | CORY DYLAN OEGEMA PA
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Gender | Male
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Dates
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Enumeration Date | 01/17/2021
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 3901 STEWART AVE
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City | WAUSAU
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State | WI
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Zip | 54401-3948
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Country | US
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Telephone | 715-907-0900
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Fax | 715-803-6977
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Provider Business Mailing Address
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Address Line | 1700 W PARADISE DR
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City | WEST BEND
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State | WI
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Zip | 53095-9795
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Country | US
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Telephone | 262-334-3451
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Fax | 262-347-3044
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5418
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License Number State | WI
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