Individual
MR. THOTSAPHONE KHAMPANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.C.
Contact information
Practice address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-6777
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
822-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42966900
—
WI
Enumeration date
12/18/2006
Last updated
12/06/2024
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