Provider Demographics
NPI:1043256159
Name:HINGTGEN, WILLIAM L (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:HINGTGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3006
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303
Mailing Address - Country:US
Mailing Address - Phone:920-499-1428
Mailing Address - Fax:920-499-5808
Practice Address - Street 1:1789 SHAWANO
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303
Practice Address - Country:US
Practice Address - Phone:920-499-1428
Practice Address - Fax:920-499-5808
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI276660202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI070050005OtherMEDICARE PTAN
1018688002OtherUNITED HC AMERICHOICE
1018688003OtherUNITED HC AMERICHOICE
300020917OtherRR MEDICARE
MI4767202Medicaid
P00028701OtherRR MEDICARE
14099OtherDEAN HEALTH
MI1997675Medicaid
567565OtherDEAN HEALTH
WI072730004OtherMEDICARE PTAN
WI30726300Medicaid
WI30726300Medicaid
WI072730004OtherMEDICARE PTAN
1018688003OtherUNITED HC AMERICHOICE