# THOMAS B. HUIZENGA, M.D.,S.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497935290
- **Authorized official:** CHARLENE D BOST (OFFICE MANAGER)
- **Authorized official phone:** (414) 961-0304

## Contact information

- **Practice address:** 525 W RIVER WOODS PKWY STE 130, GLENDALE, WI 53212-1010
- **Practice address phone:** (414) 961-0304
- **Practice address fax:** (414) 961-2061
- **Mailing address:** 2500 N MAYFAIR RD STE 500, WAUWATOSA, WI 53226-1415
- **Mailing address phone:** (414) 257-2525
- **Mailing address fax:** (414) 961-2061

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 49399 | WI | Yes |

## Other

- **Enumeration date:** 11/08/2007
- **Last updated:** 05/22/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 34874500 | — | WI |