Individual
THOMAS D PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4320 67TH DR, UNION GROVE, WI 53182-9338
(262) 878-1211
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
13227-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100221707
—
WI
Enumeration date
12/02/2022
Last updated
12/08/2025
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