MEDICARE: THOMAS THURLOW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	277.003196	IL

General Provider Information

NPI Number	:	1073153573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS THURLOW

Provider Business Mailing Address
First Line	:	6624 N FAIRFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4406
Country	:	US
Telephone Number	:	612-735-2029
Fax Number	:

Provider Business Practice Location Address
First Line	:	6624 N FAIRFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4406
Country	:	US
Telephone Number	:	612-735-2029
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	01/03/2025

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Directions to “ THOMAS THURLOW ” Practice Location

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