Provider Demographics
NPI:1841395902
Name:FEE, DOMINIC BRYAN (MD)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:BRYAN
Last Name:FEE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5200
Mailing Address - Fax:414-259-0469
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5200
Practice Address - Fax:414-259-0469
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY388552084N0400X, 2084N0600X
WI395742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1841395902Medicaid
KY64085459Medicaid
H62718Medicare UPIN