Basic Information
| Provider Information | |||||||||
| NPI: | 1043256159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HINGTGEN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 3006 | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204991428 | ||||||||
| FaxNumber: | 9204995808 | ||||||||
| Practice Location | |||||||||
| Address1: | 1789 SHAWANO | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204991428 | ||||||||
| FaxNumber: | 9204995808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 03/25/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 27666020 | WI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 070050005 | 01 | WI | MEDICARE PTAN | OTHER | 1018688002 | 01 | UNITED HC AMERICHOICE | OTHER | 1018688003 | 01 | UNITED HC AMERICHOICE | OTHER | 300020917 | 01 | RR MEDICARE | OTHER | 4767202 | 05 | MI | MEDICAID | P00028701 | 01 | RR MEDICARE | OTHER | 14099 | 01 | DEAN HEALTH | OTHER | 1997675 | 05 | MI | MEDICAID | 567565 | 01 | DEAN HEALTH | OTHER | 072730004 | 01 | WI | MEDICARE PTAN | OTHER | 30726300 | 05 | WI | MEDICAID |