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General NPI Number Information
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NPI Number | 1487093241
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Entity Type | Individual
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Provider Name | DENNIS CHARLES FLOOD PA
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Gender | Male
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Dates
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Enumeration Date | 06/14/2013
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 1700 W STOUT ST
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City | RICE LAKE
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State | WI
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Zip | 54868-5000
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Country | US
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Telephone | 715-234-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 704 PINE PL
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City | RICE LAKE
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State | WI
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Zip | 54868-2378
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Country | US
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Telephone | 507-884-9118
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3155-23
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License Number State | WI
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