Provider Demographics
NPI:1801847637
Name:HACKBARTH, DONALD A (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:A
Last Name:HACKBARTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-7424
Mailing Address - Fax:414-805-7499
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-7424
Practice Address - Fax:414-805-7499
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI21703207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1801847637Medicaid
007000215ZOtherHUMANA
B53328Medicare UPIN
WI68086 1277Medicare PIN
007000215ZOtherHUMANA