Healthcare Provider Details

I. General information

NPI: 1255594792
Provider Name (Legal Business Name): THOMAS ANTHONY GALLAGHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2008
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UW HOSPITALS AND CLINICS 600 HIGHLAND AVE DEPARTMENT OF RADIOLOGY
MADISON WI
53792-0001
US

IV. Provider business mailing address

680 N LAKE SHORE DR STE 1000
CHICAGO IL
60611-8709
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-9179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number125047921
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: