Provider Demographics
NPI:1164496162
Name:HANSEN, RICHARD MORRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MORRIS
Last Name:HANSEN
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 1:915 KURTIS DR
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2118
Mailing Address - Country:US
Mailing Address - Phone:262-797-8566
Mailing Address - Fax:
Practice Address - Street 1:791 SUMMIT AVE
Practice Address - Street 2:PROHEALTH CARE REGIONAL CANCER CENTER
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3844
Practice Address - Country:US
Practice Address - Phone:262-569-0554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19046207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30144000Medicaid
683750389Medicare PIN
WI30144000Medicaid