Basic Information
Provider Information
NPI: 1518256742
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARTL
FirstName: JOEL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8701 W WATERTOWN PLANK RD
Address2:  
City: MILWAUKEE
State: WI
PostalCode: 532263548
CountryCode: US
TelephoneNumber: 4142662000
FaxNumber:  
Practice Location
Address1: 8701 W WATERTOWN PLANK RD
Address2:  
City: MILWAUKEE
State: WI
PostalCode: 532263548
CountryCode: US
TelephoneNumber: 4142662000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/28/2011
LastUpdateDate: 03/17/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XDR.0053575COY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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