Provider Demographics
NPI:1083668354
Name:HEINRICH, THOMAS W (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:HEINRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1155 N MAYFAIR RD
Mailing Address - Street 2:BEHAVIORAL HEALTH CLINIC @ TOSA
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3421
Mailing Address - Country:US
Mailing Address - Phone:414-955-8900
Mailing Address - Fax:414-955-6295
Practice Address - Street 1:1155 N MAYFAIR RD
Practice Address - Street 2:BEHAVIORAL HEALTH CLINIC @ TOSA
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3421
Practice Address - Country:US
Practice Address - Phone:414-955-8900
Practice Address - Fax:414-955-6295
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
006000261QOtherHUMANA
WI1083668354Medicaid
G68581Medicare UPIN
WI1083668354Medicaid
006000261QOtherHUMANA