Provider Demographics
NPI:1659907533
Name:RODAWIG, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RODAWIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 30TH ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-7247
Mailing Address - Country:US
Mailing Address - Phone:712-336-0580
Mailing Address - Fax:712-336-6942
Practice Address - Street 1:2308 30TH ST UNIT 2
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-7247
Practice Address - Country:US
Practice Address - Phone:712-336-0580
Practice Address - Fax:712-336-6942
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088249332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment