Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 351025 | WI |
Y | 222Z00000X | Podiatrist | 351025 | WI |
NPI | 1033128475 |
---|---|
Provider Name | Richard L. Hecker |
First Address | Sturgeon Bay, WI 54235-1401 |
Second Address | Sturgeon Bay, WI 54235-1401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 17/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43212700 | (05) | WI |
T62162 | (02) |