Healthcare Provider Details

I. General information

NPI: 1265828560
Provider Name (Legal Business Name): ANTHONY JAMES THOMPSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 W WATERTOWN PLANK RD
MILWAUKEE WI
53226-3548
US

IV. Provider business mailing address

364 55TH ST
CLARENDON HILLS IL
60514-3015
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-8998
  • Fax:
Mailing address:
  • Phone: 612-226-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: