Provider Demographics
NPI:1740231570
Name:HELLER, DANIEL J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:HELLER
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1121 E NORTH AVE
Mailing Address - Street 2:COLUMBIA-ST. MARY'S FAMILY PRACTICE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3515
Mailing Address - Country:US
Mailing Address - Phone:414-267-6500
Mailing Address - Fax:414-267-3894
Practice Address - Street 1:1121 E NORTH AVE
Practice Address - Street 2:COLUMBIA-ST. MARY'S FAMILY PRACTICE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3515
Practice Address - Country:US
Practice Address - Phone:414-267-6500
Practice Address - Fax:414-267-3894
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-02-26
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Provider Licenses
StateLicense IDTaxonomies
WI985363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1740231570Medicaid
WI1740231570Medicaid
S54013Medicare UPIN