Healthcare Provider Details

I. General information

NPI: 1750470811
Provider Name (Legal Business Name): DAVID ALAN DUTER CEHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USCG SECTOR LAKE MICHIGAN/HS DIV 2420 S. LINCOLN MEMORIAL DR.
MILWAUKEE WI
53207
US

IV. Provider business mailing address

122 N 12TH ST
OOSTBURG WI
53070-1132
US

V. Phone/Fax

Practice location:
  • Phone: 414-747-7111
  • Fax: 414-747-7891
Mailing address:
  • Phone: 414-747-7111
  • Fax: 414-747-7891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: