Healthcare Provider Details

I. General information

NPI: 1700023447
Provider Name (Legal Business Name): JONATHAN LEUTHE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6514 ODANA RD
MADISON WI
53719-1124
US

IV. Provider business mailing address

1802 GALLOWAY ST
EAU CLAIRE WI
54703-3467
US

V. Phone/Fax

Practice location:
  • Phone: 608-829-3777
  • Fax:
Mailing address:
  • Phone: 715-831-8966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1282-060
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: