Provider Demographics
NPI:1538243068
Name:AMMEND, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:AMMEND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 UNITED WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERIC
Mailing Address - State:WI
Mailing Address - Zip Code:54837-8938
Mailing Address - Country:US
Mailing Address - Phone:715-327-4402
Mailing Address - Fax:715-327-4470
Practice Address - Street 1:203 UNITED WAY
Practice Address - Street 2:
Practice Address - City:FREDERIC
Practice Address - State:WI
Practice Address - Zip Code:54837-8938
Practice Address - Country:US
Practice Address - Phone:715-327-4402
Practice Address - Fax:715-327-4470
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33148208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN982691012462OtherPREFERRED ONE
MN1214385OtherMEDICA
MN23A92AMOtherBCBS OF MINNESOTA
WI31872700Medicaid
WI391858217014OtherBCBS OF WISCONSIN
WI31872700Medicaid