Healthcare Provider Details

I. General information

NPI: 1700331527
Provider Name (Legal Business Name): TED JAMES HEGNER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THEODORE JAMES HEGNER PA

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-5218
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-1530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085.005902
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5569
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: