Provider Demographics
NPI:1851341994
Name:TAFT, THOMAS A (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:TAFT
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 1:150 S SUNNY SLOPE RD STE 136
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4858
Mailing Address - Country:US
Mailing Address - Phone:262-786-4550
Mailing Address - Fax:262-786-4552
Practice Address - Street 1:150 S SUNNY SLOPE RD STE 136
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4858
Practice Address - Country:US
Practice Address - Phone:262-786-4550
Practice Address - Fax:262-786-4552
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24629-020207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30634600Medicaid
000302780Medicare PIN
B57039Medicare UPIN
000246330Medicare PIN