Healthcare Provider Details

I. General information

NPI: 1760911721
Provider Name (Legal Business Name): KATIE E THOMPSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 07/21/2022
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 KILEY WAY
PLYMOUTH WI
53073-5020
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 920-449-7000
  • Fax: 920-449-7088
Mailing address:
  • Phone: 920-449-7000
  • Fax: 920-449-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number72935
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: