Healthcare Provider Details

I. General information

NPI: 1558324293
Provider Name (Legal Business Name): LISA M THOMAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE CARDIOTHORACIC SURGERY
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE CARDIOTHORACIC SURGERY
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-6900
  • Fax: 414-955-6204
Mailing address:
  • Phone: 414-955-6900
  • Fax: 414-955-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1327-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: