Provider Demographics
NPI:1184617888
Name:WILLKE, THOMAS JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:WILLKE
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 1:4125 HAMILTON MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2262
Mailing Address - Country:US
Mailing Address - Phone:513-863-6222
Mailing Address - Fax:513-863-6478
Practice Address - Street 1:4125 HAMILTON MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-2262
Practice Address - Country:US
Practice Address - Phone:513-863-6222
Practice Address - Fax:513-863-6478
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH043264207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0392338Medicaid
OH0392338Medicaid
OHA78906Medicare UPIN
OH4229401Medicare PIN