Provider Demographics
NPI:1649225541
Name:ANTHONY HOANG MD SC
Entity Type:Organization
Organization Name:ANTHONY HOANG MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-820-1683
Mailing Address - Street 1:1166 QUAIL COURT SUITE 315
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5703
Mailing Address - Country:US
Mailing Address - Phone:262-370-6888
Mailing Address - Fax:262-696-6667
Practice Address - Street 1:N64W24086 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3002
Practice Address - Country:US
Practice Address - Phone:262-820-1683
Practice Address - Fax:262-784-5472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0037901207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32249600Medicaid
WI68753Medicare ID - Type Unspecified