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General NPI Number Information
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NPI Number | 1760593180
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Entity Type | Individual
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Provider Name | THOMAS HOLBROOK MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 555 S INDUSTRIAL DR SUITE 1
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City | HARTLAND
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State | WI
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Zip | 53029-2338
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Country | US
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Telephone | 262-367-7010
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Fax | 262-367-5132
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Provider Business Mailing Address
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Address Line | 555 S INDUSTRIAL DR SUITE 1
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City | HARTLAND
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State | WI
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Zip | 53029-2338
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Country | US
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Telephone | 262-367-7010
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Fax | 262-367-5132
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 17769-020
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License Number State | WI
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