Provider Demographics
NPI:1568454270
Name:WINEK, THOMAS GREG (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GREG
Last Name:WINEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1818 N MEADE ST
Mailing Address - Street 2:STE 240-WEST
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3454
Mailing Address - Country:US
Mailing Address - Phone:920-731-8289
Mailing Address - Fax:920-832-0444
Practice Address - Street 1:1818 N MEADE ST
Practice Address - Street 2:STE 240-WEST
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3454
Practice Address - Country:US
Practice Address - Phone:920-731-8289
Practice Address - Fax:920-832-0444
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI25055-020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30481000Medicaid
WI30481000Medicaid