Provider Demographics
NPI:1548234164
Name:STOIBER, THOMAS R (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:STOIBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1598
Mailing Address - Country:US
Mailing Address - Phone:608-324-2000
Mailing Address - Fax:
Practice Address - Street 1:2009 5TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1575
Practice Address - Country:US
Practice Address - Phone:608-324-2000
Practice Address - Fax:608-324-2469
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30507020207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31765600Medicaid
WIP00920574CD9551OtherRR MEDICARE
WISTOIBTHOOtherMERCYCARE INSURANCE
WIP00920574CD9551OtherRR MEDICARE
WIF08475Medicare UPIN
WI31765600Medicaid
WISTOIBTHOOtherMERCYCARE INSURANCE
WI13240Medicare ID - Type Unspecified
WI14020Medicare ID - Type Unspecified
WI032200219Medicare PIN