MEDICARE: JENNIFER THOMAS M.D.

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	208000000X	Pediatrics Physician	35632	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578573382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER THOMAS M.D.

Provider Business Mailing Address
First Line	:	100 15TH AVE
Second Line	:	#180
City	:	SOUTH MILWAUKEE
State	:	WI
Zip	:	53172-1160
Country	:	US
Telephone Number	:	414-768-5430
Fax Number	:	414-762-4225

Provider Business Practice Location Address
First Line	:	4202 W. OAKWOOD PARK CT.
Second Line	:	STE 200
City	:	FRANKLIN
State	:	WI
Zip	:	53132-9565
Country	:	US
Telephone Number	:	414-423-5250
Fax Number	:	414-423-5256

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	03/17/2023

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