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General NPI Number Information
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NPI Number | 1164496162
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Entity Type | Individual
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Provider Name | RICHARD MORRIS HANSEN MD
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Gender | Male
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 791 SUMMIT AVE PROHEALTH CARE REGIONAL CANCER CENTER
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3844
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Country | US
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Telephone | 262-569-0554
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Fax |
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Provider Business Mailing Address
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Address Line | 915 KURTIS DR
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City | ELM GROVE
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State | WI
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Zip | 53122-2118
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Country | US
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Telephone | 262-797-8566
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 19046
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License Number State | WI
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