Healthcare Provider Details

I. General information

NPI: 1073562286
Provider Name (Legal Business Name): MARK A HOENECKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3785 JANELLE LN
COTTAGE GROVE WI
53527-9569
US

IV. Provider business mailing address

3785 JANELLE LN
COTTAGE GROVE WI
53527-9569
US

V. Phone/Fax

Practice location:
  • Phone: 88-395-7466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number28943
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number28943-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: