Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2311 | WI |
Y | 103TC0700X | Clinical Psychologist | 2311 | WI |
NPI | 1013075720 |
---|---|
Provider Name | Dr. Michael Dimarco JR. |
First Address | Milwaukee, WI 53226-3462 |
Second Address | Milwaukee, WI 53226-3462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 28/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013075720 | (05) | WI |
39137100 | (05) | WI |
P68885 | (02) | WI |