Individual
DR. THOMAS ANTHONY LICATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
333 PINE RIDGE BLVD, WAUSAU, WI 54401-4102
(715) 675-3391
Mailing address
333 PINE RIDGE BLVD, WAUSAU, WI 54401-4102
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
81059-21
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/12/2021
Last updated
06/03/2024
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