Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 043264 | OH |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 043264 | OH |
NPI | 1184617888 |
---|---|
Provider Name | Dr. Thomas John Willke |
First Address | Hamilton, OH 45011-2262 |
Second Address | Hamilton, OH 45011-2262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 20/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0392338 | (05) | OH |
A78906 | (02) | OH |