Provider Demographics
NPI:1467493296
Name:DUELLMAN, TODD JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:JOSEPH
Last Name:DUELLMAN
Suffix:
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:PO BOX 8005
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-8005
Mailing Address - Country:US
Mailing Address - Phone:715-424-1881
Mailing Address - Fax:715-423-1602
Practice Address - Street 1:140 24TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-1906
Practice Address - Country:US
Practice Address - Phone:715-424-1881
Practice Address - Fax:715-423-1602
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-042504207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34866900Medicaid
WIP00346189OtherMEDICARE RAILROAD
WI720800006Medicare PIN
WI0631940001Medicare NSC
WI34866900Medicaid