Healthcare Provider Details

I. General information

NPI: 1467493296
Provider Name (Legal Business Name): TODD JOSEPH DUELLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 24TH ST S
WISCONSIN RAPIDS WI
54494-1906
US

IV. Provider business mailing address

PO BOX 8005
WISCONSIN RAPIDS WI
54495-8005
US

V. Phone/Fax

Practice location:
  • Phone: 715-424-1881
  • Fax: 715-423-1602
Mailing address:
  • Phone: 715-424-1881
  • Fax: 715-423-1602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number125-042504
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: