Gary M Hegranes, MD
Individual provider Active NPI Family Medicine Physician · Antigo, WI
NPI 1477586402 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1477586402
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 26799 (WI)
- Practice address
- 110 E 5TH Ave
Antigo, WI 54409-2710 - Phone
- (715) 623-2351
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26799 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aspirus Wausau Hospital Inc | Past | Accepting new patients | |
| Aspirus Medical Group, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 26799 | WI | Yes |
Addresses
Primary practice location
110 E 5TH Ave
Antigo, WI 54409-2710
Mailing address
3000 Westhill Dr
Suite 303
Wausau, WI 54401-3795
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30674700 | Medicaid | WI |
Other providers in Antigo, WI
- Patricia Gustafson
- Hands With Heart, LLC
- Taylor Nicole Hauser
- Hearing Advantage LLC
- Hearing Services
- Kendall Lynn Held
- Todd R Hendrickson
- Debra J Henke
- Bonnie J Hessedal
- Charles A Heuss
All providers in Antigo, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.