Provider Demographics
NPI:1932288370
Name:HETTINGER, PATRICK CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:CHRISTIAN
Last Name:HETTINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 N MAYFAIR RD
Mailing Address - Street 2:PLASTIC SURGERY CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3462
Mailing Address - Country:US
Mailing Address - Phone:414-955-1000
Mailing Address - Fax:414-955-0183
Practice Address - Street 1:1155 N MAYFAIR RD
Practice Address - Street 2:PLASTIC SURGERY CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3462
Practice Address - Country:US
Practice Address - Phone:414-955-1000
Practice Address - Fax:414-955-0183
Is Sole Proprietor?:No
Enumeration Date:2006-11-05
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51278208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1932288370Medicaid
WIK400162780Medicare PIN