Provider Demographics
NPI:1306812524
Name:MAHN, THOMAS H (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:MAHN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3070 N 51ST ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210
Mailing Address - Country:US
Mailing Address - Phone:414-442-9911
Mailing Address - Fax:414-442-8883
Practice Address - Street 1:3070 N 51ST ST
Practice Address - Street 2:SUITE 106
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210
Practice Address - Country:US
Practice Address - Phone:414-442-9911
Practice Address - Fax:414-442-8883
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI27029207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30692300Medicaid
WI30692300Medicaid
WI00000201603002Medicare ID - Type Unspecified