Provider Demographics
NPI:1609802776
Name:HEAL, GREG (MD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:
Last Name:HEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:N4W22370 BLUEMOUND ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186
Mailing Address - Country:US
Mailing Address - Phone:262-547-0199
Mailing Address - Fax:262-547-0399
Practice Address - Street 1:N4W22370 BLUEMOUND ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186
Practice Address - Country:US
Practice Address - Phone:262-547-0199
Practice Address - Fax:262-547-0399
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2016-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI31554207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31938700Medicaid
WIF63575Medicare UPIN
WI68631Medicare ID - Type Unspecified