Provider Demographics
NPI:1740676956
Name:ATZENHOEFER, MARC (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:ATZENHOEFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARC
Other - Middle Name:
Other - Last Name:ALWAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6000
Mailing Address - Fax:414-805-6280
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6000
Practice Address - Fax:414-805-6280
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66152-20207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1740676956Medicaid