Provider Demographics
NPI:1578305272
Name:DAILEY, ANTHONY LEVELL II
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LEVELL
Last Name:DAILEY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 CLARMAR DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-3013
Mailing Address - Country:US
Mailing Address - Phone:608-294-0220
Mailing Address - Fax:
Practice Address - Street 1:1444 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3009
Practice Address - Country:US
Practice Address - Phone:608-294-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WID400-0128-5370-06172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver