Basic Information
| Provider Information | |||||||||
| NPI: | 1154386878 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALSING | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 S IOWA ST | ||||||||
| Address2: | STE 102 | ||||||||
| City: | DODGEVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535331900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6089353301 | ||||||||
| FaxNumber: | 6089353823 | ||||||||
| Practice Location | |||||||||
| Address1: | 833 S IOWA ST | ||||||||
| Address2: | STE 102 | ||||||||
| City: | DODGEVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535331900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6089353301 | ||||||||
| FaxNumber: | 6089353823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 11/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 32274-020 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1154386878 | 05 | WI | MEDICAID |