Healthcare Provider Details

I. General information

NPI: 1700868957
Provider Name (Legal Business Name): THOMAS MICHAEL DOERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 PORT WASHINGTON ROAD SUITE 110
GRAFTON WI
53024-9201
US

IV. Provider business mailing address

3003 W GOOD HOPE RD
MILWAUKEE WI
53209-2042
US

V. Phone/Fax

Practice location:
  • Phone: 262-387-8300
  • Fax:
Mailing address:
  • Phone: 414-352-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number41253
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number41253-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: