Healthcare Provider Details

I. General information

NPI: 1578573382
Provider Name (Legal Business Name): JENNIFER THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER RUCKA MD

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 W. OAKWOOD PARK CT. STE 200
FRANKLIN WI
53132-9565
US

IV. Provider business mailing address

100 15TH AVE #180
SOUTH MILWAUKEE WI
53172-1160
US

V. Phone/Fax

Practice location:
  • Phone: 414-423-5250
  • Fax: 414-423-5256
Mailing address:
  • Phone: 414-768-5430
  • Fax: 414-762-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35632
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: