Provider Demographics
NPI:1114919735
Name:VANHEEST, JAMES ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLEN
Last Name:VANHEEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:201 N MAYFAIR RD
Mailing Address - Street 2:SUITE 535
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4216
Mailing Address - Country:US
Mailing Address - Phone:414-258-5130
Mailing Address - Fax:414-258-5150
Practice Address - Street 1:201 N MAYFAIR RD
Practice Address - Street 2:SUITE 535
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4216
Practice Address - Country:US
Practice Address - Phone:414-258-5130
Practice Address - Fax:414-258-5150
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI19022208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30178300Medicaid
WIB57279Medicare UPIN