Individual
THOMAS J DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 E WISCONSIN AVE, SUITE 2000, MILWAUKEE, WI 53202-4815
(414) 290-6720
(414) 290-6755
Mailing address
111 E WISCONSIN AVE, SUITE 2000, MILWAUKEE, WI 53202-4815
(414) 290-6720
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
44609-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34306000
—
WI
01
—
930126400
MEDICARE RAILROAD
WI
01
—
P00024625
MEDICARE RAILROAD
WI
01
—
P0030673
MEDICARE RAILROAD
WI
Enumeration date
05/16/2006
Last updated
01/27/2009
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