MEDICARE: JAMES J DICKMAN II M. D.

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	207Q00000X	Family Medicine Physician	18148	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902838535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES J DICKMAN II M. D.

Provider Business Mailing Address
First Line	:	N6101 NICHOLS RD
Second Line	:
City	:	BLACK RIVER FALLS
State	:	WI
Zip	:	54615-5604
Country	:	US
Telephone Number	:	715-284-5580
Fax Number	:

Provider Business Practice Location Address
First Line	:	N6101 NICHOLS RD
Second Line	:
City	:	BLACK RIVER FALLS
State	:	WI
Zip	:	54615-5604
Country	:	US
Telephone Number	:	715-284-5580
Fax Number	:

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	04/10/2014

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