Basic Information
Provider Information | |||||||||
NPI: | 1497755920 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HELF | ||||||||
FirstName: | J | ||||||||
MiddleName: | MICHAEL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HELF | ||||||||
OtherFirstName: | JAMES | ||||||||
OtherMiddleName: | MICHAEL | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1136 WESTOWNE DR | ||||||||
Address2: |   | ||||||||
City: | NEENAH | ||||||||
State: | WI | ||||||||
PostalCode: | 549562175 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9207208200 | ||||||||
FaxNumber: | 9207208131 | ||||||||
Practice Location | |||||||||
Address1: | 1136 WESTOWNE DR | ||||||||
Address2: |   | ||||||||
City: | NEENAH | ||||||||
State: | WI | ||||||||
PostalCode: | 549562175 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9207208200 | ||||||||
FaxNumber: | 9207208131 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/27/2005 | ||||||||
LastUpdateDate: | 12/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/02/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 430 | WI | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | 42929800 | 05 | WI |   | MEDICAID |