Provider Demographics
NPI:1629090410
Name:HATFIELD, MALCOLM K (MD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:K
Last Name:HATFIELD
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 1:7818 W LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3709
Mailing Address - Country:US
Mailing Address - Phone:414-281-1490
Mailing Address - Fax:414-281-1491
Practice Address - Street 1:7818 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3709
Practice Address - Country:US
Practice Address - Phone:414-281-1490
Practice Address - Fax:414-281-1491
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI299222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31514200Medicaid
WI31514200Medicaid
WI921150033Medicare ID - Type Unspecified
WI020750030Medicare ID - Type Unspecified