Healthcare Provider Details

I. General information

NPI: 1851568349
Provider Name (Legal Business Name): THOMAS A HOFBAUER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N19W26583 HONEYSUCKLE CT # B
PEWAUKEE WI
53072-5414
US

IV. Provider business mailing address

N19W26583 HONEYSUCKLE CT # B
PEWAUKEE WI
53072-5414
US

V. Phone/Fax

Practice location:
  • Phone: 262-695-2660
  • Fax:
Mailing address:
  • Phone: 262-695-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number12742-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: