Provider Demographics
NPI:1023001047
Name:BRAND, THOMAS R (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:BRAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2042
Mailing Address - Country:US
Mailing Address - Phone:414-352-3100
Mailing Address - Fax:
Practice Address - Street 1:3119 S CLEMENT AVE
Practice Address - Street 2:
Practice Address - City:BAYVIEW
Practice Address - State:WI
Practice Address - Zip Code:53207-2835
Practice Address - Country:US
Practice Address - Phone:414-486-1900
Practice Address - Fax:414-486-4148
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32217000Medicaid
WIP00627716OtherRR MEDICARE
WI46236-0359Medicare PIN
WIG24554Medicare UPIN
WI01994-0360Medicare PIN