Provider Demographics
NPI:1316593106
Name:TLOMAK, WIESLAWA (MD)
Entity Type:Individual
Prefix:DR
First Name:WIESLAWA
Middle Name:
Last Name:TLOMAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11639 N SAINT JAMES LN
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-2853
Mailing Address - Country:US
Mailing Address - Phone:414-699-7009
Mailing Address - Fax:
Practice Address - Street 1:933 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1445
Practice Address - Country:US
Practice Address - Phone:414-223-1219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49497-20207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI49497-20OtherMEDICAL LICENSE