Provider Demographics
NPI:1063738748
Name:ADAM F. DACHMAN DO SC
Entity type:Organization
Organization Name:ADAM F. DACHMAN DO SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:DACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:608-935-2018
Mailing Address - Street 1:833 S IOWA ST
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1900
Mailing Address - Country:US
Mailing Address - Phone:608-935-2018
Mailing Address - Fax:608-935-5970
Practice Address - Street 1:833 S IOWA ST
Practice Address - Street 2:SUITE 105
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1900
Practice Address - Country:US
Practice Address - Phone:608-935-2018
Practice Address - Fax:608-935-5970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36452-021208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30065100Medicaid
WI30065100Medicaid