Provider Demographics
NPI:1538103791
Name:GUDENKAUF, TAMI SUE (DO)
Entity Type:Individual
Prefix:DR
First Name:TAMI
Middle Name:SUE
Last Name:GUDENKAUF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TAMI
Other - Middle Name:SUE
Other - Last Name:VANVOORST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52004-0745
Mailing Address - Country:US
Mailing Address - Phone:800-301-5085
Mailing Address - Fax:
Practice Address - Street 1:250 MERCY DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7320
Practice Address - Country:US
Practice Address - Phone:563-589-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3349207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
33153OtherWELLMARK BCBS
185346OtherIOWA HEALTH SOLUTIONS
IA1238170Medicaid
WI43502800Medicaid
G21767Medicare UPIN
WI43502800Medicaid