Provider Demographics
NPI:1669403101
Name:JUVONEN, ANDERS V (DPM)
Entity type:Individual
Prefix:
First Name:ANDERS
Middle Name:V
Last Name:JUVONEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2929
Mailing Address - Country:US
Mailing Address - Phone:715-842-4288
Mailing Address - Fax:715-842-2162
Practice Address - Street 1:115 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2929
Practice Address - Country:US
Practice Address - Phone:715-842-4288
Practice Address - Fax:715-842-2162
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI437-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43241200Medicaid
WI43241200Medicaid
WI0979180001Medicare NSC
WI000082391Medicare PIN