Provider Demographics
NPI:1245341858
Name:DUNTEMAN, JUDITH ERIN (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ERIN
Last Name:DUNTEMAN
Suffix:
Gender:F
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 25331
Mailing Address - Street 2:SJO 4028
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33102-5331
Mailing Address - Country:US
Mailing Address - Phone:325-480-0735
Mailing Address - Fax:
Practice Address - Street 1:7979 NW 21ST ST
Practice Address - Street 2:SJO 4028
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1616
Practice Address - Country:US
Practice Address - Phone:325-480-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN46710OtherSTATE LICENSE
MNI11928Medicare UPIN