Provider Demographics
NPI:1629135306
Name:HANSON, RITA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:MARIE
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:M
Other - Last Name:MELZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13950 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2441
Mailing Address - Country:US
Mailing Address - Phone:414-302-5404
Mailing Address - Fax:
Practice Address - Street 1:13950 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2441
Practice Address - Country:US
Practice Address - Phone:414-302-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30266500Medicaid
3908168571A4OtherBLUE CROSS BLUE SHIELD
000001389Medicare ID - Type Unspecified
3908168571A4OtherBLUE CROSS BLUE SHIELD