=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609802776
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREG HEAL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 02/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N4W22370 BLUEMOUND ROAD SUITE 100
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-547-0199
-----------------------------------------------------
Fax | 262-547-0399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N4W22370 BLUEMOUND ROAD SUITE 100
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-547-0199
-----------------------------------------------------
Fax | 262-547-0399
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 31554
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------