Healthcare Provider Details

I. General information

NPI: 1124656996
Provider Name (Legal Business Name): HANNA HEINTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

999 N 92ND ST STE 730
MILWAUKEE WI
53226-4875
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2626
  • Fax: 414-266-2496
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number76401
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: