Provider Demographics
NPI:1558381202
Name:THOMAS, ANNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 COUNTY RD I
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729
Mailing Address - Country:US
Mailing Address - Phone:715-720-3780
Mailing Address - Fax:715-720-3781
Practice Address - Street 1:2503 COUNTY RD I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729
Practice Address - Country:US
Practice Address - Phone:715-720-3780
Practice Address - Fax:715-720-3781
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41695-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H29745Medicare UPIN