Provider Demographics
NPI:1215177167
Name:DONALD E. DLOUHY LLC
Entity type:Organization
Organization Name:DONALD E. DLOUHY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DLOUHY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-781-8693
Mailing Address - Street 1:12728 W HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:WI
Mailing Address - Zip Code:53007-1602
Mailing Address - Country:US
Mailing Address - Phone:262-781-8693
Mailing Address - Fax:262-781-1468
Practice Address - Street 1:12728 W HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:WI
Practice Address - Zip Code:53007-1602
Practice Address - Country:US
Practice Address - Phone:262-781-8693
Practice Address - Fax:262-781-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1863-035261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38519900Medicaid
WIDE41133OtherSPECTERA
WIDE41133OtherSPECTERA
WI38519900Medicaid