Provider Demographics
NPI:1144450412
Name:THOMAS, MARK W (DPM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2405 SCHOFIELD AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2300
Mailing Address - Country:US
Mailing Address - Phone:715-241-8100
Mailing Address - Fax:715-241-8102
Practice Address - Street 1:2405 SCHOFIELD AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-2300
Practice Address - Country:US
Practice Address - Phone:715-241-8100
Practice Address - Fax:715-241-8102
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2012-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI1001-25213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist