Provider Demographics
NPI:1871501452
Name:ALTEPETER, THOMAS S (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:ALTEPETER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 ALGOMA BLVD.
Mailing Address - Street 2:STE B
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-2104
Mailing Address - Country:US
Mailing Address - Phone:920-385-7273
Mailing Address - Fax:920-385-0140
Practice Address - Street 1:1936 ALGOMA BLVD.
Practice Address - Street 2:STE B
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2104
Practice Address - Country:US
Practice Address - Phone:920-385-7273
Practice Address - Fax:920-385-0140
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1320-057103T00000X
WI1320103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39085000Medicaid
WI39085000Medicaid
WIR80398Medicare UPIN
84075-0007Medicare ID - Type UnspecifiedMEDICARE PROVIDER