Provider Demographics
NPI:1174679385
Name:RYMUT, AUGUST F JR (MD)
Entity Type:Individual
Prefix:
First Name:AUGUST
Middle Name:F
Last Name:RYMUT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 N PROSPECT AVE
Mailing Address - Street 2:UNIT 909
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2445
Mailing Address - Country:US
Mailing Address - Phone:414-223-7909
Mailing Address - Fax:
Practice Address - Street 1:1660 N PROSPECT AVE
Practice Address - Street 2:909
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2400
Practice Address - Country:US
Practice Address - Phone:414-223-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17267174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30956800Medicaid
WI30956800Medicaid