Provider Demographics
NPI:1265475719
Name:MARCINIAK, THOMAS ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROBERT
Last Name:MARCINIAK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7049 W PINEBERRY RDG
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8565
Mailing Address - Country:US
Mailing Address - Phone:414-427-1999
Mailing Address - Fax:414-427-1999
Practice Address - Street 1:7049 W PINEBERRY RDG
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8565
Practice Address - Country:US
Practice Address - Phone:414-427-1999
Practice Address - Fax:414-427-1999
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI461-25213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43217100Medicaid
480013588OtherRAILROAD MEDICARE ID #
2719090001OtherDMERC
480013588OtherRAILROAD MEDICARE ID #
WI43217100Medicaid
WI000085870Medicare ID - Type Unspecified
WIP00953287Medicare PIN
WI850700017Medicare PIN
WIP00953287Medicare PIN
WI864810024Medicare PIN
WI810150014Medicare PIN