Basic Information
| Provider Information | |||||||||
| NPI: | 1417948225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENZEL | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1204 LAKEVIEW DR APT 2 | ||||||||
| Address2: | 1204 LAKEVIEW DR. APT 2 | ||||||||
| City: | TOMAH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546601076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7128307280 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 E HIGHWAY 18 | ||||||||
| Address2: | |||||||||
| City: | PINE RIDGE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058675131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2005 | ||||||||
| LastUpdateDate: | 03/06/2013 | ||||||||
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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 | 208600000X | 30154 | IA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 51000 | WI | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.