Provider Demographics
NPI:1326308511
Name:HEIDENREICH, WAYNE FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:FRANCIS
Last Name:HEIDENREICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:720 E WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4703
Mailing Address - Country:US
Mailing Address - Phone:414-661-4990
Mailing Address - Fax:414-661-3915
Practice Address - Street 1:720 E WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4703
Practice Address - Country:US
Practice Address - Phone:414-661-4990
Practice Address - Fax:414-661-3915
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29637-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine