Provider Demographics
NPI:1043289473
Name:HASSELHOF, GERT (MD)
Entity Type:Individual
Prefix:DR
First Name:GERT
Middle Name:
Last Name:HASSELHOF
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:N2437 E MINER DR
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-8382
Mailing Address - Country:US
Mailing Address - Phone:608-475-0328
Mailing Address - Fax:
Practice Address - Street 1:N2437 E MINER DR
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-8382
Practice Address - Country:US
Practice Address - Phone:608-475-0328
Practice Address - Fax:715-256-5452
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34927207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32071200Medicaid
WI32071200Medicaid
F90129Medicare UPIN
WI001500486Medicare PIN
WI080127868Medicare PIN