Provider Demographics
NPI:1700870607
Name:CHULSKI, THOMAS G (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:CHULSKI
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 1:900 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:WAUTOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54982-6944
Mailing Address - Country:US
Mailing Address - Phone:920-787-6900
Mailing Address - Fax:920-787-6903
Practice Address - Street 1:900 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982-6944
Practice Address - Country:US
Practice Address - Phone:920-787-6900
Practice Address - Fax:920-787-6903
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32626700Medicaid
H12960Medicare UPIN
WI32626700Medicaid