Provider Demographics
NPI:1679023014
Name:VONRUEDEN, WILLIAM A (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:VONRUEDEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2600 N MAYFAIR RD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1309
Mailing Address - Country:US
Mailing Address - Phone:414-727-8380
Mailing Address - Fax:414-727-8555
Practice Address - Street 1:2600 N MAYFAIR RD
Practice Address - Street 2:SUITE 505
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1309
Practice Address - Country:US
Practice Address - Phone:414-727-8380
Practice Address - Fax:414-727-8555
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI3911-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant