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General NPI Number Information
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NPI Number | 1295837425
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Entity Type | Organization
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Legal Business Name | MARK P HASTINGS, DPM, SC
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 3431 N 51ST BLVD
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City | MILWAUKEE
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State | WI
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Zip | 53216-3228
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Country | US
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Telephone | 262-255-1040
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Fax | 262-255-4090
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Provider Business Mailing Address
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Address Line | N86W16462 JACOBSON DR
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-2833
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Country | US
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Telephone | 262-255-1040
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Fax | 262-255-4090
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK P HASTINGS
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Credential | DPM
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Telephone | 414-873-0772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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