Provider Demographics
NPI:1760593180
Name:HOLBROOK, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:HOLBROOK
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 1:555 S INDUSTRIAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-2338
Mailing Address - Country:US
Mailing Address - Phone:262-367-7010
Mailing Address - Fax:262-367-5132
Practice Address - Street 1:555 S INDUSTRIAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-2338
Practice Address - Country:US
Practice Address - Phone:262-367-7010
Practice Address - Fax:262-367-5132
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17769-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31228300Medicaid
WI0031-44255Medicare ID - Type Unspecified
WI31228300Medicaid