Healthcare Provider Details

I. General information

NPI: 1619929411
Provider Name (Legal Business Name): ERIC J HOHENWALTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE DEPT OF RADIOLOGY
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE DEPT OF RADIOLOGY
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-3700
  • Fax: 414-805-3777
Mailing address:
  • Phone: 414-805-3700
  • Fax: 414-805-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number41422
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: