Basic Information
Provider Information
NPI: 1841307469
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HRON
FirstName: JOHN
MiddleName: RAYMOND
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3301 W FOREST HOME AVE
Address2:  
City: MILWAUKEE
State: WI
PostalCode: 532152843
CountryCode: US
TelephoneNumber: 4146476326
FaxNumber: 4146718860
Practice Location
Address1: 2629 N 7TH ST
Address2:  
City: SHEBOYGAN
State: WI
PostalCode: 530834998
CountryCode: US
TelephoneNumber: 9204515553
FaxNumber: 9204515113
Other Information
ProviderEnumerationDate: 08/23/2006
LastUpdateDate: 07/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X19505WIY Allopathic & Osteopathic PhysiciansEmergency Medicine 

ID Information
IDTypeStateIssuerDescription
3120720005WI MEDICAID
AH257897801 DEA NUMBEROTHER


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