Healthcare Provider Details

I. General information

NPI: 1295837425
Provider Name (Legal Business Name): MARK P HASTINGS, DPM, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3431 N 51ST BLVD
MILWAUKEE WI
53216-3228
US

IV. Provider business mailing address

N86W16462 JACOBSON DR
MENOMONEE FALLS WI
53051-2833
US

V. Phone/Fax

Practice location:
  • Phone: 262-255-1040
  • Fax: 262-255-4090
Mailing address:
  • Phone: 262-255-1040
  • Fax: 262-255-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK P HASTINGS
Title or Position: PRESIDENT
Credential: DPM
Phone: 414-873-0772