Organization
THOMAS B. HUIZENGA, M.D.,S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLENE D BOST (OFFICE MANAGER)
(414) 961-0304
Entity
Organization
Contact information
Practice address
525 W RIVER WOODS PKWY STE 130, GLENDALE, WI 53212-1010
(414) 961-0304
(414) 961-2061
Mailing address
2500 N MAYFAIR RD STE 500, WAUWATOSA, WI 53226-1415
(414) 257-2525
(414) 961-2061
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
49399
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34874500
—
WI
Enumeration date
11/08/2007
Last updated
05/22/2019
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