Provider Demographics
NPI:1861447146
Name:HASENYAGER, CAROL A (MD)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:HASENYAGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:H
Other - Last Name:LIRELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3267 S 16TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4500
Mailing Address - Country:US
Mailing Address - Phone:414-389-2780
Mailing Address - Fax:
Practice Address - Street 1:3267 S 16TH ST STE 108
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-389-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27983207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30751800Medicaid
WI1861447146Medicaid
WI30751800Medicaid
WI680860398Medicare PIN
B53456Medicare UPIN