Provider Demographics
NPI:1982719266
Name:KALINOSKY, THOMAS J (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:KALINOSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:215 CORPORATE DR
Mailing Address - Street 2:STE G
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3123
Mailing Address - Country:US
Mailing Address - Phone:920-887-7692
Mailing Address - Fax:920-887-7694
Practice Address - Street 1:215 CORPORATE DR
Practice Address - Street 2:SUITE G
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3123
Practice Address - Country:US
Practice Address - Phone:920-887-7692
Practice Address - Fax:920-887-7694
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI24188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30016200Medicaid
80179Medicare ID - Type Unspecified
WI30016200Medicaid