Individual
MARK L THAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
257 W SAINT GEORGE AVE, GRANTSBURG, WI 54840-7827
(715) 463-5353
(715) 463-2753
Mailing address
257 W SAINT GEORGE AVE, GRANTSBURG, WI 54840-7827
(715) 463-5353
(715) 463-2753
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
32528
WI
208600000X
Surgery Physician
31570
MN
208600000X
Surgery Physician
Primary
32528
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
918723500
—
MN
Enumeration date
04/04/2006
Last updated
07/21/2022
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