Provider Demographics
NPI:1992876734
Name:THOMAS J KALINOSKY DO
Entity type:Organization
Organization Name:THOMAS J KALINOSKY DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KALINOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:920-887-7692
Mailing Address - Street 1:215 CORPORATE DR
Mailing Address - Street 2:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43959900Medicaid
WI30016200Medicaid
WI80179Medicare ID - Type Unspecified
WI30016200Medicaid
WIB53973Medicare UPIN