Provider Demographics
NPI:1780659193
Name:HORNEFFER, ELIZABETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:HORNEFFER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-542-2536
Mailing Address - Fax:262-542-2791
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 115
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-542-2536
Practice Address - Fax:262-542-2791
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI342302080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32057900Medicaid
WI32057900Medicaid