Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mary J Derse-Hayes, PA

Individual provider Physician Assistant · NPI 1679675557

Mary J Derse-Hayes, PA is a Physician Assistant in Milwaukee, Wisconsin. Qualified in 2006, 20 years ago. Practices with Froedtert Andthe Medical College of Wisconsin Community Physicians Inc, a 1,255-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
20
Licensed in
WI
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

2350 N Lake Dr Ste 302
Milwaukee, WI 53211-4528
Phone: (414) 298-7104
Fax: (414) 298-7117
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 2046 (WI)

Record details

NPI number1679675557
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedSeptember 2, 2006
Last updated in NPPESNovember 9, 2016

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Froedtert Andthe Medical College Of Wisconsin Community Physicians Inc — 1255 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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