Provider Demographics
NPI:1306882394
Name:DAHNERT, WOLFGANG F (MD)
Entity type:Individual
Prefix:
First Name:WOLFGANG
Middle Name:F
Last Name:DAHNERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 GREENBRIER RD
Mailing Address - Street 2:PO BOX 8900
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54308-8900
Mailing Address - Country:US
Mailing Address - Phone:920-288-4930
Mailing Address - Fax:920-288-4941
Practice Address - Street 1:2845 GREENBRIER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:920-288-4930
Practice Address - Fax:920-288-4941
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI473002085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00155944OtherRAILROAD
MI104642674Medicaid
WI34579900Medicaid
WIB41619Medicare UPIN
MI104642674Medicaid