Individual
DR. BRIAN J HETTRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8400 WASHINGTON AVE, MOUNT PLEASANT, WI 53406-3735
(262) 884-4088
Mailing address
25405 103RD ST, SALEM, WI 53168-8915
(262) 909-8169
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41149
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32558300
—
WI
01
—
P00248375
RAIL ROAD MEDICARE
—
Enumeration date
04/05/2006
Last updated
02/13/2024
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