Provider Demographics
NPI:1326277765
Name:DONOVAN, S. THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:S.
Middle Name:THOMAS
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:S.
Other - Middle Name:THOMAS
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3222 KNOLLWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3416
Mailing Address - Country:US
Mailing Address - Phone:608-271-4224
Mailing Address - Fax:608-271-4224
Practice Address - Street 1:3222 KNOLLWOOD WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-3416
Practice Address - Country:US
Practice Address - Phone:608-271-4224
Practice Address - Fax:608-271-4224
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17946020207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology