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NPI Code Detail

MEDICARE: CHRISTOPHER DIMINO

MEDICARE: CHRISTOPHER DIMINO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
22255A2300XAthletic Trainer2457-39WI

General Provider Information

NPI Number : 1104367192
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER DIMINO
Provider Business Mailing Address
First Line : 2000 E LAYTON AVE
Second Line :
City : ST FRANCIS
State : WI
Zip : 53235-6053
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2000 E LAYTON AVE
Second Line :
City : SAINT FRANCIS
State : WI
Zip : 53235-6053
Country : US
Telephone Number : 608-575-2799
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2017
Last Update Date : 09/22/2021

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Directions to “ CHRISTOPHER DIMINO ” Practice Location

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