Bruce A Van Dommelen, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

28110 Issued in WI

Practice address

2920 Superior Ave
Sheboygan, WI 53081-1944

Phone

(920) 458-3791

Fax

(920) 458-3783

NPI assigned

Oct 10, 2005

Last updated

Nov 2, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sheboygan Internal Medicine Associates, SC

  • Internal Medicine Physician
  • Sheboygan, WI
  • NPI 1922161728
  NPD
• Sheboygan Surgical Associates, S.C.

  • Surgery Physician
  • Sheboygan, WI
  • NPI 1972629145
  NPD
• Anesthesiology Associates of Sheboygan, LTD.

  • Anesthesiology Physician
  • Sheboygan, WI
  • NPI 1518914357
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320192000000",
    "number": "1740278241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 SUPERIOR AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811944",
            "telephone_number": "920-458-3791",
            "fax_number": "920-458-3783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 SUPERIOR AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811944",
            "telephone_number": "920-458-3791",
            "fax_number": "920-458-3783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DOMMELEN",
        "first_name": "BRUCE",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2011-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WI",
            "license": "28110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30783400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeanne Marie Valicenti, MD
• Ganna Valinova
• Elizabeth Valley, PHARMD
• Adria Van Asten
• Devon Van Beek, DPM
• Cheryl Van Ells
• Beth Morgan Van Ess, APNP, FNP-BC
• Diane Lynn Vandeguchte, R.N
• Debra Lee Vanderweele, M.A.
• Melanie Vaness

• Orthopaedic Surgery Physician in Sheboygan, WI
• Providers in Sheboygan, WI by specialty
• Orthopaedic Surgery Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.