Provider Demographics
NPI:1346209475
Name:MINIOR, THOMAS MATHEW (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MATHEW
Last Name:MINIOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1982 N PROSPECT AVE
Mailing Address - Street 2:APT. #2B
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1494
Mailing Address - Country:US
Mailing Address - Phone:414-220-9860
Mailing Address - Fax:
Practice Address - Street 1:765 KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019
Practice Address - Country:US
Practice Address - Phone:202-469-4699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI45869OtherSTATE LICENSE NUMBER
WI34402800Medicaid
WI45869OtherSTATE LICENSE NUMBER