Healthcare Provider Details

I. General information

NPI: 1487767042
Provider Name (Legal Business Name): MARJORIE C HAWKINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 EAST WEBSTER PLACE SUITE 203
MILWAUKEE WI
53211-4253
US

IV. Provider business mailing address

2524 EAST WEBSTER PLACE SUITE 203
MILWAUKEE WI
53211-4253
US

V. Phone/Fax

Practice location:
  • Phone: 414-964-9200
  • Fax:
Mailing address:
  • Phone: 414-964-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35309-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: