Provider Demographics
NPI:1053303362
Name:MULTERER, THUCANH T (MD)
Entity Type:Individual
Prefix:
First Name:THUCANH
Middle Name:T
Last Name:MULTERER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 LYNN ST
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-8000
Mailing Address - Country:US
Mailing Address - Phone:920-917-9631
Mailing Address - Fax:
Practice Address - Street 1:841 LYNN ST
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-8000
Practice Address - Country:US
Practice Address - Phone:920-917-9631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301109210207W00000X, 207WX0107X
OH128264207W00000X, 207WX0107X
WI52490-20207W00000X
IN99102474A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60040/0411Medicare PIN