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NPI Code Detail

MEDICARE: CHARLES J HEYKA MD

MEDICARE: CHARLES J HEYKA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QG0300XGeriatric Medicine (Family Medicine) Physician49636-020WI
2207Q00000XFamily Medicine Physician49636-020WI

General Provider Information

NPI Number : 1083721286
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES J HEYKA MD
Provider Business Mailing Address
First Line : PO BOX 1866
Second Line :
City : GREEN BAY
State : WI
Zip : 54305-1866
Country : US
Telephone Number : 920-445-7222
Fax Number : 920-445-7289
Provider Business Practice Location Address
First Line : 820 ARBUTUS AVE
Second Line :
City : OCONTO
State : WI
Zip : 54153-2004
Country : US
Telephone Number : 920-835-1100
Fax Number : 920-835-1099
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2006
Last Update Date : 09/20/2019

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