Healthcare Provider Details

I. General information

NPI: 1336177864
Provider Name (Legal Business Name): JASON C TOMPKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/07/2023
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 N SAINT JOSEPH AVE
NILES MI
49120-2207
US

IV. Provider business mailing address

1000 N OAK AVE
MARSHFIELD WI
54449-5703
US

V. Phone/Fax

Practice location:
  • Phone: 269-687-5510
  • Fax: 269-684-0189
Mailing address:
  • Phone: 715-387-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4301083277
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number64047
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: