Healthcare Provider Details

I. General information

NPI: 1306812524
Provider Name (Legal Business Name): THOMAS H MAHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 N 51ST ST SUITE 106
MILWAUKEE WI
53210
US

IV. Provider business mailing address

3070 N 51ST ST SUITE 106
MILWAUKEE WI
53210
US

V. Phone/Fax

Practice location:
  • Phone: 414-442-9911
  • Fax: 414-442-8883
Mailing address:
  • Phone: 414-442-9911
  • Fax: 414-442-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number27029
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number27029
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: