Provider Demographics
NPI:1881681385
Name:AHMANN, THOMAS (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:AHMANN
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 1:201 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2852
Mailing Address - Country:US
Mailing Address - Phone:573-581-7582
Mailing Address - Fax:573-581-7583
Practice Address - Street 1:201 E MONROE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2852
Practice Address - Country:US
Practice Address - Phone:573-581-7582
Practice Address - Fax:573-581-7583
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31266208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A12030Medicare UPIN