Provider Demographics
NPI:1770518540
Name:MCGOREY, THOMAS M (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:MCGOREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:147 W ROCKWELL ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-2048
Mailing Address - Country:US
Mailing Address - Phone:920-674-6255
Mailing Address - Fax:920-674-5288
Practice Address - Street 1:1225 REMMEL DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53094-8511
Practice Address - Country:US
Practice Address - Phone:920-674-6255
Practice Address - Fax:920-674-5288
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI38070-20207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32416700Medicaid