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General NPI Number Information
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NPI Number | 1700966256
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Entity Type | Organization
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Legal Business Name | ROGER L. HEPPERLA, M.D., S.C.
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 10900 W POTTER RD
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City | WAUWATOSA
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State | WI
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Zip | 53226-3424
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Country | US
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Telephone | 414-774-9227
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Fax |
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Provider Business Mailing Address
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Address Line | 225 S EXECUTIVE DR
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City | BROOKFIELD
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State | WI
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Zip | 53005-4266
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Country | US
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Telephone | 262-787-4026
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER L HEPPERLA
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Credential | M.D.
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Telephone | 414-774-9227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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