Provider Demographics
NPI:1386722866
Name:D'AMICO, MICHAEL D (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:D'AMICO
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 1:100-15TH AVE.
Mailing Address - Street 2:STE. 180
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1160
Mailing Address - Country:US
Mailing Address - Phone:414-423-5250
Mailing Address - Fax:414-423-5256
Practice Address - Street 1:4202 W. OAKWOOD PARK CT
Practice Address - Street 2:STE 200
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8131
Practice Address - Country:US
Practice Address - Phone:414-423-5250
Practice Address - Fax:414-423-5256
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32195100Medicaid