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NPI Code Detail

MEDICARE: THOMAS WONDERLICH MD

MEDICARE: THOMAS WONDERLICH 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
1207Q00000XFamily Medicine PhysicianM13796ID
2207Q00000XFamily Medicine Physician9495056-1205UT

General Provider Information

NPI Number : 1982016788
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS WONDERLICH MD
Provider Business Mailing Address
First Line : 2003 KOOTENAI HEALTH WAY
Second Line :
City : COEUR D ALENE
State : ID
Zip : 83814-6051
Country : US
Telephone Number : 208-476-5777
Fax Number : 208-476-5385
Provider Business Practice Location Address
First Line : 301 CEDAR ST
Second Line :
City : OROFINO
State : ID
Zip : 83544-9029
Country : US
Telephone Number : 208-476-5777
Fax Number : 208-476-5385
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2014
Last Update Date : 03/17/2026

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Directions to “ THOMAS WONDERLICH MD” Practice Location

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