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General NPI Number Information
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NPI Number | 1922338953
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Entity Type | Individual
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Provider Name | SAMUEL J RUNDE WISCONSIN LICENSED H
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Gender | Male
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 2055 HOLLIDAY DR STE 340
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City | DUBUQUE
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State | IA
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Zip | 52002-0415
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Country | US
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Telephone | 563-513-8623
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Fax |
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Provider Business Mailing Address
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Address Line | 3750 SANDY HOOK RD
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City | HAZEL GREEN
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State | WI
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Zip | 53811-9319
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Country | US
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Telephone | 563-513-8623
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 709-60
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License Number State | WI
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