=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417834565
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMONHEART, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2025
-----------------------------------------------------
Last Update Date | 08/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N16W23217 STONE RIDGE DR STE 350
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53188-1171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-206-4930
-----------------------------------------------------
Fax | 920-261-7327
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1045 HILL ST
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53098-3015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-206-4930
-----------------------------------------------------
Fax | 920-261-7327
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JUSTIN MUNZEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 920-328-1029
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------