Provider Demographics
NPI:1871793612
Name:KUFAHL JANICKI, HILLARY A (MD)
Entity type:Individual
Prefix:DR
First Name:HILLARY
Middle Name:A
Last Name:KUFAHL JANICKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19475 W NORTH AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BORRKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4199
Mailing Address - Country:US
Mailing Address - Phone:262-780-4000
Mailing Address - Fax:262-780-4090
Practice Address - Street 1:19475 W NORTH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4199
Practice Address - Country:US
Practice Address - Phone:262-780-4000
Practice Address - Fax:262-780-4090
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN11110207V00000X
WI55212207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology