MEDICARE: INDIA HERTEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1305-140	WI

General Provider Information

NPI Number	:	1528669983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDIA HERTEL

Provider Business Mailing Address
First Line	:	1021 W NATIONAL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1347
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 W NATIONAL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1347
Country	:	US
Telephone Number	:	920-393-8320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	12/19/2025

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Directions to “ INDIA HERTEL ” Practice Location

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