Individual
DR. THOMAS JAMES PERCIVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-8000
Mailing address
PO BOX 735041, CHICAGO, IL 60673-5041
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
R0929
TX
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
81046
WI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
R0929
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100218117
—
WI
05
—
384973902
—
TX
01
—
384973903
CSHCN
TX
Enumeration date
06/09/2008
Last updated
10/25/2024
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