Provider Demographics
NPI:1689929499
Name:HENKE, TIMOTHY (DPM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HENKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 MILWAUKEE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1380
Mailing Address - Country:US
Mailing Address - Phone:262-763-9007
Mailing Address - Fax:262-758-6134
Practice Address - Street 1:2500 W LAYTON AVE STE 170
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5433
Practice Address - Country:US
Practice Address - Phone:262-763-9007
Practice Address - Fax:262-758-6134
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1047-25213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery