MEDICARE: MAI TONG THAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	16929-33	WI

General Provider Information

NPI Number	:	1144108598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAI TONG THAO

Provider Business Mailing Address
First Line	:	155 N DECHANT RD
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-3906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6737 W WASHINGTON ST STE 2150
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-5649
Country	:	US
Telephone Number	:	414-238-1771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2025
Last Update Date	:	08/25/2025

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Directions to “ MAI TONG THAO ” Practice Location

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