Individual
JONATHAN GREGORY TLACHAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
975 PORT WASHINGTON RD, GRAFTON, WI 53024-9201
(262) 329-2135
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(262) 329-2135
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
54241
WI
207L00000X
Anesthesiology Physician
MD436211
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100008639
—
WI
Enumeration date
05/29/2009
Last updated
10/09/2023
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