Healthcare Provider Details

I. General information

NPI: 1134180045
Provider Name (Legal Business Name): THOMAS C PUCHNER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5763 N HILL CT
FITCHBURG WI
53711-5299
US

IV. Provider business mailing address

5763 N HILL CT
FITCHBURG WI
53711-5299
US

V. Phone/Fax

Practice location:
  • Phone: 608-278-8303
  • Fax:
Mailing address:
  • Phone: 608-278-8303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number27062
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number27062
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: