MEDICARE: KURT W. REDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	275	SD

General Provider Information

NPI Number	:	1639321904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURT W. REDER

Provider Business Mailing Address
First Line	:	1030 14TH ST SE
Second Line	:
City	:	WATERTOWN
State	:	SD
Zip	:	57201-5328
Country	:	US
Telephone Number	:	605-886-4104
Fax Number	:	605-886-4104

Provider Business Practice Location Address
First Line	:	1030 14TH ST SE
Second Line	:
City	:	WATERTOWN
State	:	SD
Zip	:	57201-5328
Country	:	US
Telephone Number	:	605-886-4104
Fax Number	:	605-886-4104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	10/17/2008

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