Healthcare Provider Details

I. General information

NPI: 1497662233
Provider Name (Legal Business Name): MR. MICHAEL HANTKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 N 20TH ST
MILWAUKEE WI
53205-1140
US

IV. Provider business mailing address

2820 N 75TH ST
MILWAUKEE WI
53210-1022
US

V. Phone/Fax

Practice location:
  • Phone: 414-935-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: