Provider Demographics
NPI:1942251699
Name:THOMPSON, RONALD H (PAC)
Entity Type:Individual
Prefix:MS
First Name:RONALD
Middle Name:H
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12915 PRESIDENT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-8028
Mailing Address - Country:US
Mailing Address - Phone:262-785-1621
Mailing Address - Fax:
Practice Address - Street 1:FROEDTERT HOSPITAL
Practice Address - Street 2:9200 WEST WISCONSIN AVENUE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-456-6907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42927400Medicaid
WI42927400Medicaid