Provider Demographics
NPI:1184276792
Name:PUFFETT, THOMAS ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALLEN
Last Name:PUFFETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:920-104-5043
Practice Address - Street 1:2414 KOHLER MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3129
Practice Address - Country:US
Practice Address - Phone:920-104-5043
Practice Address - Fax:920-459-1408
Is Sole Proprietor?:No
Enumeration Date:2019-07-13
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI7716851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100174934Medicaid