Provider Demographics
NPI:1346209475
Name:MINIOR, THOMAS MATHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MATHEW
Last Name:MINIOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1982 N PROSPECT AVE
Mailing Address - Street 2:APT. #2B
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1494
Mailing Address - Country:US
Mailing Address - Phone:414-220-9860
Mailing Address - Fax:
Practice Address - Street 1:2555 N MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2709
Practice Address - Country:US
Practice Address - Phone:414-286-6855
Practice Address - Fax:414-286-6851
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI45869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34402800Medicaid
WI45869OtherSTATE LICENSE NUMBER
WI45869OtherSTATE LICENSE NUMBER