Provider Demographics
NPI:1053376426
Name:ROHRDANZ, RUSSELL G (AUD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:G
Last Name:ROHRDANZ
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 FISH HATCHERY RD
Mailing Address - Street 2:DEAN MEDICAL CENTER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1911
Mailing Address - Country:US
Mailing Address - Phone:608-252-8000
Mailing Address - Fax:608-252-8245
Practice Address - Street 1:1313 FISH HATCHERY RD
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1911
Practice Address - Country:US
Practice Address - Phone:608-252-8000
Practice Address - Fax:608-252-8245
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI328-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6489OtherDEAN HEALTH INSURANCE
WI6489OtherDEAN HEALTH INSURANCE
WI640003664Medicare PIN
S90582Medicare UPIN
WI059374150Medicare PIN