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NPI Code Detail

MEDICARE: DR. WIESLAWA TLOMAK MD

MEDICARE:  DR. WIESLAWA  TLOMAK  MD
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
1207ZF0201XForensic Pathology Physician49497-20WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
149497-20OTHERWIMEDICAL LICENSE

General Provider Information

NPI Number : 1316593106
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WIESLAWA TLOMAK MD
Provider Business Mailing Address
First Line : 11639 N SAINT JAMES LN
Second Line :
City : MEQUON
State : WI
Zip : 53092-2853
Country : US
Telephone Number : 414-699-7009
Fax Number :
Provider Business Practice Location Address
First Line : 933 W HIGHLAND AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-1445
Country : US
Telephone Number : 414-223-1219
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2019
Last Update Date : 08/16/2019

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Directions to “ DR. WIESLAWA TLOMAK MD” Practice Location

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