Provider Demographics
NPI:1912998576
Name:FENSKE, THOMAS G (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:FENSKE
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2801 W. KINNICKINNIC RIVER PKWY.
Mailing Address - Street 2:SUITE 925
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215
Mailing Address - Country:US
Mailing Address - Phone:414-385-2499
Mailing Address - Fax:414-385-2748
Practice Address - Street 1:2801 W. KINNICKINNIC RIVER PKWY.
Practice Address - Street 2:SUITE 925
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-385-2499
Practice Address - Fax:414-385-2748
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI32284207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32279000Medicaid
WI32279000Medicaid
WI000001017Medicare ID - Type Unspecified