Provider Demographics
NPI:1063035749
Name:AMUNDSON, AARON ALBERT (DO)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:ALBERT
Last Name:AMUNDSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6912 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57107-0338
Mailing Address - Country:US
Mailing Address - Phone:507-318-0846
Mailing Address - Fax:
Practice Address - Street 1:933 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1445
Practice Address - Country:US
Practice Address - Phone:414-223-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI81421-21207ZF0201X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology