MEDICARE: DAGMARA Z. BEINE PA-C

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
1	363A00000X	Physician Assistant	1738-023	WI

General Provider Information

NPI Number	:	1770684482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAGMARA Z. BEINE PA-C

Provider Business Mailing Address
First Line	:	2640 VIOLET CT
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-1458
Country	:	US
Telephone Number	:	262-752-0313
Fax Number	:

Provider Business Practice Location Address
First Line	:	8201 S HOWELL AVE
Second Line	:	SUITE 400
City	:	OAK CREEK
State	:	WI
Zip	:	53135
Country	:	US
Telephone Number	:	414-570-1120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	03/18/2008

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