Healthcare Provider Details

I. General information

NPI: 1790736536
Provider Name (Legal Business Name): ANDREA HOOGERLAND GILLESPIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. ANDREA HOOGERLAND

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-3666
  • Fax: 262-560-1579
Mailing address:
  • Phone: 414-805-3666
  • Fax: 262-560-1579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number44090
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number157827
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number49538
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD157827
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number44090
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: