Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 75451 | WI |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 75451 | WI |
NPI | 1043604960 |
---|---|
Provider Name | James R Heaberlin |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Milwaukee, WI 53215-4330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2015 |
Last Update Date | 02/12/2021 |