# MAPLE MEDICAL SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487152104
- **Authorized official:** HARRY HOSTETLER MD (OWNER)
- **Authorized official phone:** (262) 875-5070

## Contact information

- **Practice address:** 2428 N GRANDVIEW BLVD STE 102, WAUKESHA, WI 53188-6906
- **Practice address phone:** (877) 307-3226
- **Practice address fax:** (877) 307-3226
- **Mailing address:** PO BOX 474, HARTLAND, WI 53029-0474
- **Mailing address phone:** (877) 307-3226
- **Mailing address fax:** (866) 384-9486

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RG0300X | Geriatric Medicine (Internal Medicine) Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |

## Other

- **Enumeration date:** 01/28/2018
- **Last updated:** 10/07/2026