Healthcare Provider Details

I. General information

NPI: 1255389581
Provider Name (Legal Business Name): HEALTH DYNAMICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 N PROSPECT AVE UNIT 1302
MILWAUKEE WI
53202-6525
US

IV. Provider business mailing address

1522 N PROSPECT AVE UNIT 1302
MILWAUKEE WI
53202-6525
US

V. Phone/Fax

Practice location:
  • Phone: 414-573-0007
  • Fax: 414-290-6755
Mailing address:
  • Phone: 414-573-0007
  • Fax: 414-290-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS A REMINGA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 414-290-6700