Individual
EVAN HENRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9200 W WISCONSIN AVE, DIVISION OF GERIATRICS, MILWAUKEE, WI 53226-3522
(414) 805-6850
(414) 805-6864
Mailing address
9200 W WISCONSIN AVE, GERIATRICS, MILWAUKEE, WI 53226-3522
(414) 805-6850
(414) 805-6864
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
70409
WI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
70409
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578094835
—
WI
Enumeration date
03/27/2017
Last updated
09/12/2023
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