Provider Demographics
NPI:1336483312
Name:PUTTKAMER, MICHAEL E (HIS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:PUTTKAMER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 GALLOWAY ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-3467
Mailing Address - Country:US
Mailing Address - Phone:715-831-8966
Mailing Address - Fax:715-831-8968
Practice Address - Street 1:4664 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3236
Practice Address - Country:US
Practice Address - Phone:608-243-8084
Practice Address - Fax:608-249-0157
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1323-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist