Basic Information
| Provider Information | |||||||||
| NPI: | 1447211404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 SUMMIT AVE | ||||||||
| Address2: | PROHEALTH CARE MEDICAL ASSOCIATES FP | ||||||||
| City: | OCONOMOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530663973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625670223 | ||||||||
| FaxNumber: | 2625676380 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 SUMMIT AVE | ||||||||
| Address2: | PROHEALTH CARE MEDICAL ASSOCIATES FP | ||||||||
| City: | OCONOMOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530663973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625670223 | ||||||||
| FaxNumber: | 2625676380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 01/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 22410 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.