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NPI Code Detail

MEDICARE: MARK L THAYER MD

MEDICARE: MARK L THAYER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician32528WI
2208600000XSurgery Physician31570MN
3208600000XSurgery Physician32528WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568424778
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK L THAYER MD
Provider Business Mailing Address
First Line : 257 W SAINT GEORGE AVE
Second Line :
City : GRANTSBURG
State : WI
Zip : 54840-7827
Country : US
Telephone Number : 715-463-5353
Fax Number : 715-463-2753
Provider Business Practice Location Address
First Line : 257 W SAINT GEORGE AVE
Second Line :
City : GRANTSBURG
State : WI
Zip : 54840-7827
Country : US
Telephone Number : 715-463-5353
Fax Number : 715-463-2753
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2006
Last Update Date : 07/21/2022

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