Basic Information
| Provider Information | |||||||||
| NPI: | 1255358883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSIER | ||||||||
| FirstName: | THOMAS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10625 W NORTH AVE | ||||||||
| Address2: | 102 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532262315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148775350 | ||||||||
| FaxNumber: | 4148775360 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 W CHAMBERS ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532101650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144472000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 46670 | WI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 20A8717 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 036-098236 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 02001867A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 43523900 | 05 | WI | MEDICAID |