Provider Demographics
NPI:1982288825
Name:THAO, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:THAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W143N5009 BROOK FALLS DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-6987
Mailing Address - Country:US
Mailing Address - Phone:414-758-3287
Mailing Address - Fax:
Practice Address - Street 1:12714 W HAMPTON AVE STE F
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:WI
Practice Address - Zip Code:53007-1640
Practice Address - Country:US
Practice Address - Phone:414-758-3287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver