Healthcare Provider Details

I. General information

NPI: 1881273290
Provider Name (Legal Business Name): DUSTIN HEJDAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2021
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 W LINCOLN AVE
MILWAUKEE WI
53227-1133
US

IV. Provider business mailing address

12760 W NORTH AVE BLDG A
BROOKFIELD WI
53005-4628
US

V. Phone/Fax

Practice location:
  • Phone: 800-767-4411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number77051-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: