Individual
THOMAS J CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
145 N MAIN ST, FOND DU LAC, WI 54935-3423
(920) 926-8492
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
15778
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12581
DEAN
WI
05
—
31081500
—
WI
01
—
WI0148
JOHN DEERE
WI
Enumeration date
12/15/2005
Last updated
11/06/2007
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