Healthcare Provider Details

I. General information

NPI: 1477536282
Provider Name (Legal Business Name): STEPHEN J HEANEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W180N8085 TOWN HALL RD DEPT OF ANESTHESIOLOGY
MENOMONEE FALLS WI
53051-3518
US

IV. Provider business mailing address

W180N8085 TOWN HALL RD DEPT OF ANESTHESIOLOGY
MENOMONEE FALLS WI
53051-3518
US

V. Phone/Fax

Practice location:
  • Phone: 262-251-1000
  • Fax:
Mailing address:
  • Phone: 262-251-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number32732-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: