| Provider / Organization | NPI | Date Certified |
|---|---|---|
| CORY DYLAN OEGEMA | 1295324929 | 2021-01-17 |
Cory Dylan Oegema is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1295324929. Registration indicates Cory Dylan Oegema is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)
| Entity Type | Individual |
| Provider Name | Mr. Cory Dylan Oegema PA |
| Practice Office Address | 1700 W PARADISE DR WEST BEND, WI US |
| Practice Office Telephone | 2623343451 |
| Practice Office Fax | 2623473044 |
| Mailing Address | 1700 W PARADISE DR WEST BEND, WI 530959795 US |
| Business Telephone | 2623343451 |
| Business Fax | 2623473044 |
| Direct Messaging Address [] | [email protected] |
| Code | Practice | License No State |
|---|---|---|
| 363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | 5418
WI |
| 1295324929 | MEDICAID | WI |