Healthcare Provider Details

I. General information

NPI: 1699336446
Provider Name (Legal Business Name): EDWARD FRANK HURTTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12203 N CORPORATE PKWY
MEQUON WI
53092-3388
US

IV. Provider business mailing address

12203 N CORPORATE PKWY
MEQUON WI
53092-3388
US

V. Phone/Fax

Practice location:
  • Phone: 262-387-8200
  • Fax:
Mailing address:
  • Phone: 262-387-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number87163-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: