Provider Demographics
NPI:1275694648
Name:TUOMINEN, TERRENCE C (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:C
Last Name:TUOMINEN
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 1:1615 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3610
Mailing Address - Country:US
Mailing Address - Phone:715-685-6010
Mailing Address - Fax:715-682-2804
Practice Address - Street 1:1615 MAPLE LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3610
Practice Address - Country:US
Practice Address - Phone:715-685-6010
Practice Address - Fax:715-682-2804
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081506174400000X, 207Y00000X
WI37070207Y00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104798862Medicaid
MITT081506OtherBCBS LICENSE
MITT081506OtherBCBS LICENSE
G20446Medicare UPIN
WI004960123Medicare PIN
MI104798862Medicaid