Provider Demographics
NPI:1336190164
Name:HEUER, DALE K (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:K
Last Name:HEUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:925 N 87TH ST
Mailing Address - Street 2:MED COLLEGE CLINICS AT THE EYE INST
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4812
Mailing Address - Country:US
Mailing Address - Phone:414-456-2020
Mailing Address - Fax:414-456-6300
Practice Address - Street 1:925 N 87TH ST
Practice Address - Street 2:MED COLLEGE CLINICS AT THE EYE INST
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4812
Practice Address - Country:US
Practice Address - Phone:414-456-2020
Practice Address - Fax:414-456-6300
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22702207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1336190164Medicaid
002000226COtherHUMANA
002000226COtherHUMANA
WI020H73601Medicare PIN