Provider Demographics
NPI:1962517128
Name:DUDLEY, JOANN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:C
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:S48W34533 RUE CHANTILLY
Mailing Address - Street 2:
Mailing Address - City:DOUSMAN
Mailing Address - State:WI
Mailing Address - Zip Code:53118-9620
Mailing Address - Country:US
Mailing Address - Phone:262-244-7457
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:915 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3921
Practice Address - Country:US
Practice Address - Phone:262-560-3700
Practice Address - Fax:262-569-2266
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29862207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1962517128Medicaid
BD1876688OtherDEA NUMBER
VAOOX771T01Medicare PIN
E48779Medicare UPIN
P00652764Medicare PIN