Provider Demographics
NPI:1316574874
Name:HASELHORST, CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:HASELHORST
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 1:15255 WATERTOWN PLANK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2338
Mailing Address - Country:US
Mailing Address - Phone:414-404-9768
Mailing Address - Fax:
Practice Address - Street 1:15255 WATERTOWN PLANK RD STE 200
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2338
Practice Address - Country:US
Practice Address - Phone:414-404-9768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI76072-20208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice