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NPI Code Detail

MEDICARE: KATHY SUSAN HERNANDEZ M.D.

MEDICARE: KATHY SUSAN HERNANDEZ M.D.
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
1207Q00000XFamily Medicine Physician32458WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2810127286OTHERWIPRIVATEHEALTHCARE SYSTEM
34654337OTHERWIAETNA
43596782OTHERWICIGNA

General Provider Information

NPI Number : 1164427654
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHY SUSAN HERNANDEZ M.D.
Provider Business Mailing Address
First Line : 1032 S CESAR E CHAVEZ DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53204-2203
Country : US
Telephone Number : 414-672-1353
Fax Number : 414-672-4265
Provider Business Practice Location Address
First Line : 1032 S CESAR E CHAVEZ DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53204-2203
Country : US
Telephone Number : 414-672-1353
Fax Number : 414-672-4265
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 03/07/2023

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