Provider Demographics
NPI:1093775090
Name:HOSTETLER, HARRY B (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:B
Last Name:HOSTETLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-0474
Mailing Address - Country:US
Mailing Address - Phone:262-875-5070
Mailing Address - Fax:866-384-9486
Practice Address - Street 1:1625 COLDWATER CREEK DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-8028
Practice Address - Country:US
Practice Address - Phone:262-521-8800
Practice Address - Fax:262-521-8870
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47738207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34855200Medicaid
WI34855200Medicaid
WI683750615Medicare PIN
WI002668280Medicare PIN