Provider Demographics
NPI:1700970894
Name:SAPHNER, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:SAPHNER
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:PO BOX 13453
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-3453
Mailing Address - Country:US
Mailing Address - Phone:920-884-3135
Mailing Address - Fax:920-884-3271
Practice Address - Street 1:1726 SHAWANO AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3216
Practice Address - Country:US
Practice Address - Phone:920-884-3135
Practice Address - Fax:920-884-3271
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057902207RX0202X
WI28471207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102766162Medicaid
WI31483800Medicaid
MITS057902OtherBCBS MI
WI31483800Medicaid
MITS057902OtherBCBS MI
MIM84790001Medicare ID - Type Unspecified
110089289Medicare ID - Type UnspecifiedRAILROAD MEDICARE