Healthcare Provider Details

I. General information

NPI: 1871090142
Provider Name (Legal Business Name): JONATHAN WILLIAM THOMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 REGENT ST
MADISON WI
53705-4901
US

IV. Provider business mailing address

PSC 78 BOX 6739
APO AP
96326-0068
US

V. Phone/Fax

Practice location:
  • Phone: 608-233-9746
  • Fax: 608-233-0026
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018028929
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: