Healthcare Provider Details

I. General information

NPI: 1023280831
Provider Name (Legal Business Name): JENNIFER HENNINGFELD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER BERG

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE PEDIATRIC PULMONARY MEDICINE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE PEDIATRIC PULMONARY MEDICINE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-6730
  • Fax: 414-266-6742
Mailing address:
  • Phone: 414-266-6730
  • Fax: 414-266-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54323
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number54323
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number54323
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: