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General NPI Number Information
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NPI Number | 1992876734
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Entity Type | Organization
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Legal Business Name | THOMAS J KALINOSKY DO
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 215 CORPORATE DR SUITE G
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City | BEAVER DAM
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State | WI
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Zip | 53916-3123
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Country | US
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Telephone | 920-887-7692
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Fax | 920-887-7694
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Provider Business Mailing Address
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Address Line | 215 CORPORATE DR SUITE G
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City | BEAVER DAM
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State | WI
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Zip | 53916-3123
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Country | US
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Telephone | 920-887-7692
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Fax | 920-887-7694
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Authorized Official
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Title or Position | OWNER DO
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Name | DR. THOMAS J KALINOSKY
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Credential | DO
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Telephone | 920-887-7692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24188
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License Number State | WI
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