Healthcare Provider Details

I. General information

NPI: 1255892790
Provider Name (Legal Business Name): ROBERT W HEFFERNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W180N8085 TOWN HALL RD
MENOMONEE FALLS WI
53051-3518
US

IV. Provider business mailing address

W180N8085 TOWN HALL RD
MENOMONEE FALLS WI
53051-3518
US

V. Phone/Fax

Practice location:
  • Phone: 262-532-1300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number74064-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: