Healthcare Provider Details

I. General information

NPI: 1932136652
Provider Name (Legal Business Name): THOMAS A REMINGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 N PROSPECT AVE UNIT 1302
MILWAUKEE WI
53202-6525
US

IV. Provider business mailing address

1522 N PROSPECT AVE UNIT 1302
MILWAUKEE WI
53202-6525
US

V. Phone/Fax

Practice location:
  • Phone: 414-573-0007
  • Fax:
Mailing address:
  • Phone: 414-573-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number20168-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: