Healthcare Provider Details

I. General information

NPI: 1447315510
Provider Name (Legal Business Name): LARRY THOMAS HEGLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MINISTRY PKWY SAINT CLARE'S HOSPITAL
WESTON WI
54476-5220
US

IV. Provider business mailing address

3403 HIDDEN LINKS DR
WAUSAU WI
54403-9127
US

V. Phone/Fax

Practice location:
  • Phone: 715-393-2487
  • Fax: 715-359-1087
Mailing address:
  • Phone: 715-241-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number48942
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC1-0005692
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: