Individual
TOMMY HA QUACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
W180N8085 TOWN HALL RD, MENOMONEE FALLS, WI 53051-3518
(262) 251-1000
(262) 518-5052
Mailing address
11011 W NORTH AVE APT 469, WAUWATOSA, WI 53226-2275
(832) 228-2979
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
179-17
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100146572
—
WI
Enumeration date
01/04/2021
Last updated
01/31/2024
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