Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kenneth J Heidle, DO

Individual provider Emergency Medicine Physician · NPI 1083059604

Kenneth J Heidle, DO is an Emergency Medicine in Pleasant Prairie, Wisconsin. Graduated from Lake Erie College of Osteopathic Medicine, Erie in 2013, 13 years ago. Practices with Froedtert South Inc, a 156-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Pennsylvania and Wisconsin.

Years since qualifying
13
Trained at
Lake Erie College of Osteopathic Medicine, Erie
Licensed in
PA, WI
In the registry since
2013
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

See every abbreviation used in this directory →

Practice location Address checks out

9555 76th St
Pleasant Prairie, WI 53158-1984
Phone: (414) 290-6720
Fax: (414) 290-6755
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 232 W 25th St, Erie, PA 16544-0002 — (814) 452-5000
  • 6308 8th Ave, Kenosha, WI 53143-5031 — (414) 290-6720

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 67107-21 (WI)
Emergency Medicine Physician Taxonomy 207P00000X · Licence OT015080 (PA)

Record details

NPI number1083059604
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedMay 9, 2013
Last updated in NPPESDecember 28, 2021
Certification dateDecember 28, 2021
Mailing address111 E Wisconsin Ave Ste 2000, Milwaukee, WI 53202-4809

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolLAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE, ERIE
Graduated 2013 (13 years in practice)
Group practice Froedtert South Inc — 156 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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