Provider Demographics
NPI:1063609329
Name:FLUNKER, RICHARD (HIS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:FLUNKER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CORPORATE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-1281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:920-887-9655
Practice Address - Street 1:3416 MILL RD
Practice Address - Street 2:SUITE 10
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-2058
Practice Address - Country:US
Practice Address - Phone:920-451-1100
Practice Address - Fax:920-887-9655
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1199-060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42836400Medicaid