Provider Demographics
NPI:1235144031
Name:HASENBERG-GINDT, JILL ANNE (DO)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANNE
Last Name:HASENBERG-GINDT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANNE
Other - Last Name:HASENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:OAKLEAF CLINICS, S.C.
Mailing Address - Street 2:3802 OAKWOOD MALL DR.
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3016
Mailing Address - Country:US
Mailing Address - Phone:715-839-9280
Mailing Address - Fax:
Practice Address - Street 1:855 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-1687
Practice Address - Country:US
Practice Address - Phone:715-839-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45018-21207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI105706OtherGMP
WI864421046263OtherPREFERRED ONE
WIW005284OtherCHAMPUS
WIP00311902OtherTRAVELERS RR
WIH77832Medicare UPIN
WI43503200Medicaid
WI11030-0007Medicare ID - Type Unspecified
WV43503200OtherWRISK
WIH77832OtherGROUP HEALTH
WI01-23529OtherMEDICA