Individual
THOMAS THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
117 E GREEN BAY ST, SHAWANO, WI 54166-2443
(715) 524-2161
(715) 524-5658
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 996-3298
(920) 738-5787
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21092
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30106900
—
WI
Enumeration date
06/27/2006
Last updated
04/24/2008
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