Provider Demographics
NPI:1255390209
Name:HAYEK, ANTOINETTE GONZAGA (MD)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:GONZAGA
Last Name:HAYEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:
Other - Last Name:GONZAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-847-3000
Mailing Address - Fax:
Practice Address - Street 1:2727 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4129
Practice Address - Country:US
Practice Address - Phone:715-847-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20080309173000000X
WI62545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM344532-003Medicare UPIN
NMH18475Medicare UPIN
NMB0264Medicaid