Provider Demographics
NPI:1871118174
Name:MENKE, DALTON STEPHEN (PA-C)
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:STEPHEN
Last Name:MENKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2600 N MAYFAIR RD STE 810
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1328
Practice Address - Country:US
Practice Address - Phone:414-771-1122
Practice Address - Fax:414-771-1352
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2025-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI8117-23363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant