Provider Demographics
NPI:1922347194
Name:JESSICA L. HOELZLE
Entity Type:Organization
Organization Name:JESSICA L. HOELZLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOELZLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-527-2521
Mailing Address - Street 1:5128 N 64TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4005
Mailing Address - Country:US
Mailing Address - Phone:414-527-2521
Mailing Address - Fax:414-527-0638
Practice Address - Street 1:2311 N PROSPECT AVE
Practice Address - Street 2:UNIT C
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4445
Practice Address - Country:US
Practice Address - Phone:414-319-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5454220207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI025250511Medicare PIN