Provider Demographics
NPI:1932150687
Name:MOFFIC, HILLARD S (MD)
Entity Type:Individual
Prefix:DR
First Name:HILLARD
Middle Name:S
Last Name:MOFFIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:H
Other - Last Name:MOFFICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10000 W INNOVATION DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4837
Mailing Address - Country:US
Mailing Address - Phone:414-456-5006
Mailing Address - Fax:414-456-6259
Practice Address - Street 1:CAMPUS CLINIC - TOSA CENTER
Practice Address - Street 2:1155 NORTH MAYFAIR ROAD
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-805-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI300702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31519300Medicaid
0084273601Medicare ID - Type Unspecified