Individual
TOM PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4855 S MOORLAND RD FL 3, NEW BERLIN, WI 53151-7494
(262) 432-7599
(262) 432-7694
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 476-8559
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
75525
WI
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
T7331
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366939795
—
WI
Enumeration date
04/20/2018
Last updated
12/19/2022
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