Provider Demographics
NPI:1649363698
Name:HILTON, JONATHAN H (DPM)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:H
Last Name:HILTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 BUENA PARK RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-7991
Mailing Address - Country:US
Mailing Address - Phone:414-963-0816
Mailing Address - Fax:
Practice Address - Street 1:4020 BUENA PARK RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-7991
Practice Address - Country:US
Practice Address - Phone:414-963-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI457213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43200400Medicaid
WI000082808Medicare ID - Type Unspecified
WI43200400Medicaid
WI4787960001Medicare NSC