Provider Demographics
NPI:1871181065
Name:QUACH, TOMMY HA (CAA)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:HA
Last Name:QUACH
Suffix:
Gender:M
Credentials:CAA
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Mailing Address - Street 1:11011 W NORTH AVE APT 469
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2275
Mailing Address - Country:US
Mailing Address - Phone:832-228-2979
Mailing Address - Fax:
Practice Address - Street 1:W180N8085 TOWN HALL RD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3518
Practice Address - Country:US
Practice Address - Phone:262-251-1000
Practice Address - Fax:262-518-5052
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2024-01-31
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Provider Licenses
StateLicense IDTaxonomies
WI179-17367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100146572Medicaid