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Individual

SHAWN P HENNIGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2323 N CASALOMA DR, APPLETON, WI 54913-8284
(920) 730-8833
Mailing address
3467 COUNTRY WINDS CT, GREEN BAY, WI 54311-6906
(920) 639-7751

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
45657
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104507348
MI
05
104641130
MI
05
104705943
MI
05
104788310
MI
05
34380900
WI
01
P00011123
RAILROAD
WI
Enumeration date
06/29/2006
Last updated
04/18/2020
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