Provider Demographics
NPI:1417931932
Name:TAFELSKI, THOMAS JAMES (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:TAFELSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3355 GLENDALE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-2777
Mailing Address - Fax:419-383-2731
Practice Address - Street 1:3100 MAIN ST STE 705
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9867
Practice Address - Country:US
Practice Address - Phone:419-383-2777
Practice Address - Fax:419-383-2731
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0561708Medicaid
OH0561708Medicaid
OHTA0543071Medicare ID - Type Unspecified