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NPI Code Detail

MEDICARE: DR. JOHNATHAN DANIEL DALLAS MD

MEDICARE: DR. JOHNATHAN DANIEL DALLAS MD
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
1208000000XPediatrics Physician102237-851WI

General Provider Information

NPI Number : 1386586261
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHNATHAN DANIEL DALLAS MD
Provider Business Mailing Address
First Line : 600 HIGHLAND AVE
Second Line :
City : MADISON
State : WI
Zip : 53792-0001
Country : US
Telephone Number : 608-263-6400
Fax Number :
Provider Business Practice Location Address
First Line : 600 HIGHLAND AVE
Second Line :
City : MADISON
State : WI
Zip : 53792-0001
Country : US
Telephone Number : 608-263-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2026
Last Update Date : 06/04/2026

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Directions to “ DR. JOHNATHAN DANIEL DALLAS MD” Practice Location

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