Healthcare Provider Details

I. General information

NPI: 1285924969
Provider Name (Legal Business Name): THOMAS J. GUHL, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 S 20TH ST STE 150
MILWAUKEE WI
53215-4941
US

IV. Provider business mailing address

225 S EXECUTIVE DR
BROOKFIELD WI
53005-4257
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2011
  • Fax: 414-384-2700
Mailing address:
  • Phone: 262-787-4026
  • Fax: 262-782-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number32298
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number32298
License Number StateWI

VIII. Authorized Official

Name: THOMAS J GUHL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 262-787-4026