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NPI Code Detail

MEDICARE: DR. THOMAS TACKMAN MD

MEDICARE: DR. THOMAS TACKMAN 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
1207R00000XInternal Medicine Physician30509WI

General Provider Information

NPI Number : 1902802416
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS TACKMAN MD
Provider Business Mailing Address
First Line : PO BOX 249
Second Line :
City : FORT ATKINSON
State : WI
Zip : 53538-0249
Country : US
Telephone Number : 920-563-5571
Fax Number : 920-563-7705
Provider Business Practice Location Address
First Line : 611 SHERMAN AVE E
Second Line :
City : FORT ATKINSON
State : WI
Zip : 53538-1960
Country : US
Telephone Number : 920-563-5571
Fax Number : 920-563-7705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 12/17/2025

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