Individual
GREGORY HEISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2801 W KINNICKINNIC RIVER PKWY STE 575, MILWAUKEE, WI 53215-5200
(414) 649-3240
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5513-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100039113
—
WI
Enumeration date
11/04/2013
Last updated
10/09/2023
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