Provider Demographics
NPI:1225320450
Name:NANDA, THIM P (MD)
Entity Type:Individual
Prefix:
First Name:THIM
Middle Name:P
Last Name:NANDA
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 1:3255 TOWN CRIER CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-3017
Mailing Address - Country:US
Mailing Address - Phone:262-781-2872
Mailing Address - Fax:262-781-2872
Practice Address - Street 1:3255 TOWN CRIER CT
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3017
Practice Address - Country:US
Practice Address - Phone:262-781-2872
Practice Address - Fax:262-781-2872
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21954-20208100000X
WI21954208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation