Dominguez, Marie A

Dominguez, Marie A is an sole proprietor health care provider with primary practice located at 1100 Gateway Ct , West Bend WI 53095-8539. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Hospitalist is her primary health care specialty. Dominguez, Marie A can be contacted via phone (262) 335-8600.

Contact Information

Primary practice address
1100 Gateway Ct West Bend WI 53095-8539
Phone: (262) 335-8600
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 68577 Wisconsin
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X 68577 Wisconsin

Profile Details

NPI number 1952312886
LBN Legal business name Dominguez, Marie A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 9th, 2006
Last updated Apr 2nd, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952312886 NPPES
Wisconsin MEDICAID 100074618

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