Healthcare Provider Details

I. General information

NPI: 1932255981
Provider Name (Legal Business Name): GREENLUND ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 COUNTY RD HQ SUITE 5
MARQUETTE MI
49855-8855
US

IV. Provider business mailing address

1802 GALLOWAY ST
EAU CLAIRE WI
54703-3467
US

V. Phone/Fax

Practice location:
  • Phone: 906-228-3577
  • Fax: 906-228-9670
Mailing address:
  • Phone: 715-831-8966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT R LAU
Title or Position: OWNER
Credential:
Phone: 715-831-8966