Provider Demographics
NPI:1275550790
Name:CHELIMSKY, THOMAS C (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:CHELIMSKY
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 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5200
Mailing Address - Fax:414-259-0469
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5200
Practice Address - Fax:414-259-0469
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0596282084N0400X
WI565462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH741859OtherBUCKEYE MEDICAID
OH0646970OtherAETNA
WI1275550790Medicaid
130009063OtherMCR RR
OH000000510663OtherANTHEM
OH000000221114OtherUNISON
OH363416OtherWELLCARE MEDICAID
OH0777888Medicaid
PA1008507150001Medicaid
OHP00420562OtherMEDICARE RAILROAD
PA1008507150001Medicaid
WI73601 2364Medicare PIN
OHP00420562OtherMEDICARE RAILROAD
WI68086 1153Medicare PIN
OHCH4059329Medicare PIN