Provider Demographics
NPI:1952554966
Name:HISGEN, WILLIAM JEROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEROLD
Last Name:HISGEN
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 1:1215 GARFIELD ST
Mailing Address - Street 2:1215 GARFIELD ST.
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2215
Mailing Address - Country:US
Mailing Address - Phone:608-256-3489
Mailing Address - Fax:
Practice Address - Street 1:1215 GARFIELD ST
Practice Address - Street 2:1215 GARFIELD ST.
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2215
Practice Address - Country:US
Practice Address - Phone:608-256-3489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16404207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine