Provider Demographics
NPI:1750387684
Name:HYMAN, ALAN A (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:A
Last Name:HYMAN
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 1:16140 HORTON RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7937
Mailing Address - Country:US
Mailing Address - Phone:262-857-1113
Mailing Address - Fax:866-853-4506
Practice Address - Street 1:16140 HORTON RD.
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7937
Practice Address - Country:US
Practice Address - Phone:262-857-1133
Practice Address - Fax:866-853-4506
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24838 020207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL131378200OtherU.S. DEPARTMENT OF LABOR
WI5105450001OtherADMINASTART FEDERAL
IL036057784Medicaid
WI036 057 784OtherTOTAL CARE
WI310148100OtherU.S. DEPARTMENT OF LABOR
IL98181OtherBLUE SHIELD OF IOWA
ILL003708OtherCHAMPUS
WI4256749OtherAETNA
WI364552255011OtherBLUE SHIELD
IL036057784Medicaid