Individual
DR. MANUEL DE JESUS THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1107 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4617
(414) 463-2607
Mailing address
1107 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4617
(414) 463-2607
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
47171
WI
207QA0401X
Addiction Medicine (Family Medicine) Physician
47171
WI
207QA0505X
Adult Medicine Physician
47171
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
038.147540
STATE OF IL
IL
Enumeration date
10/04/2006
Last updated
03/07/2019
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