Provider Demographics
NPI:1669693461
Name:BARBARA A HUMMEL, MD SC
Entity type:Organization
Organization Name:BARBARA A HUMMEL, MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-604-0520
Mailing Address - Street 1:4811 S 76TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4364
Mailing Address - Country:US
Mailing Address - Phone:414-604-0520
Mailing Address - Fax:414-604-0525
Practice Address - Street 1:4811 S 76TH ST STE 201
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4364
Practice Address - Country:US
Practice Address - Phone:414-604-0520
Practice Address - Fax:414-604-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30414207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000002589Medicare ID - Type Unspecified