Individual
KENNETH J HEIDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
9555 76TH ST, PLEASANT PRAIRIE, WI 53158-1984
(414) 290-6720
(414) 290-6755
Mailing address
111 E WISCONSIN AVE STE 2000, MILWAUKEE, WI 53202-4809
(414) 290-6720
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
67107-21
WI
207P00000X
Emergency Medicine Physician
OT015080
PA
Other
Enumeration date
05/09/2013
Last updated
12/28/2021
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