Provider Demographics
NPI:1992788707
Name:HENKEL, PHILIP S (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:S
Last Name:HENKEL
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 1:2256 18TH ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-9537
Mailing Address - Country:US
Mailing Address - Phone:715-234-7011
Mailing Address - Fax:
Practice Address - Street 1:2256 18TH ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-9537
Practice Address - Country:US
Practice Address - Phone:715-234-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25781-020207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30735300Medicaid
WI30735300Medicaid
WIB53544Medicare UPIN
WI0003-05085Medicare ID - Type UnspecifiedPROVIDER NUMBER
WI0001-05125Medicare ID - Type UnspecifiedPROVIDER NUMBER