Basic Information
| Provider Information | |||||||||
| NPI: | 1538132360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANTIERI | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2130 BIG BEND RD | ||||||||
| Address2: | PROHEALTH CARE MEDICAL ASSOCIATES INC | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531897624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629287555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2130 BIG BEND RD | ||||||||
| Address2: | PROHEALTH CARE MEDICAL ASSOCIATES INC | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531897624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629287555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 04/25/2012 | ||||||||
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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 | 207R00000X | 31040 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31582700 | 05 | WI | MEDICAID |