Healthcare Provider Details

I. General information

NPI: 1316593106
Provider Name (Legal Business Name): WIESLAWA TLOMAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 W HIGHLAND AVE
MILWAUKEE WI
53233-1445
US

IV. Provider business mailing address

11639 N SAINT JAMES LN
MEQUON WI
53092-2853
US

V. Phone/Fax

Practice location:
  • Phone: 414-223-1219
  • Fax:
Mailing address:
  • Phone: 414-699-7009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number49497-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: