MEDICARE: HEIDI HUGHES PA-C

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	363AM0700X	Medical Physician Assistant	1977	WI

General Provider Information

NPI Number	:	1548209695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI HUGHES PA-C

Provider Business Mailing Address
First Line	:	7974 UW HEALTH CT
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-5531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 PARK AVE
Second Line	:
City	:	COLUMBUS
State	:	WI
Zip	:	53925-2401
Country	:	US
Telephone Number	:	920-623-5226
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	02/15/2021

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