Provider Demographics
NPI:1497704324
Name:THORACIC SURGERY ASSOCIATES, LTD
Entity Type:Organization
Organization Name:THORACIC SURGERY ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:JUST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-258-0670
Mailing Address - Street 1:3333 N MAYFAIR RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3219
Mailing Address - Country:US
Mailing Address - Phone:414-258-0670
Mailing Address - Fax:
Practice Address - Street 1:3333 N MAYFAIR RD
Practice Address - Street 2:SUITE 209
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-3219
Practice Address - Country:US
Practice Address - Phone:414-258-0670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14300208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE8852OtherRR MEDICARE
WV21301300Medicaid