Provider Demographics
NPI:1265424162
Name:KOMP, THOMAS R (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:KOMP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:KOMP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:1800 LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9108
Practice Address - Country:US
Practice Address - Phone:920-983-3220
Practice Address - Fax:920-983-3226
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI534-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41732500OtherMEDICAID DME
WI43205900Medicaid
WI0256660001OtherMEDICARE DME
WI000081004Medicare ID - Type Unspecified
WI41732500OtherMEDICAID DME