Provider Demographics
NPI:1699858811
Name:TRANNEL, THOMAS JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:TRANNEL
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 1:700 WEST AVE S
Mailing Address - Street 2:PHYSICIAN SERVICES
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4783
Mailing Address - Country:US
Mailing Address - Phone:608-392-4156
Mailing Address - Fax:608-392-9898
Practice Address - Street 1:212 11TH ST S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4116
Practice Address - Country:US
Practice Address - Phone:608-392-9555
Practice Address - Fax:608-392-9432
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI378522084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32240800Medicaid
127378OtherUCARE
MN84G00TROtherBCBS-MN
HP66205OtherHEALTHPARTNERS
390821863003OtherTRICARE-HEALTH NET
MN81G02TROtherBCBS-MN
MN953023100Medicaid
390821863003OtherTRICARE-HEALTH NET
MN81G02TROtherBCBS-MN
WI32240800Medicaid