MEDICARE: THOMAS A. EISEMAN M.D.

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	207P00000X	Emergency Medicine Physician	036102548	IL
2	207R00000X	Internal Medicine Physician	036102548	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00884750	OTHER		MEDICARE RAILROAD PTAN (INDIVIDUAL)
5	206147	OTHER	IL	MEDICARE GROUP PTAN
6	CA4748	OTHER		MEDICARE RAILROAD PTAN (GROUP)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3631498336019001	OTHER	IL	HFS GROUP PAYEE ID
3	0222075	OTHER	IL	BLUE CROSS GROUP ID
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	1033149844	OTHER	IL	GROUP NPI

General Provider Information

NPI Number	:	1073514360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS A. EISEMAN M.D.

Provider Business Mailing Address
First Line	:	25 N. WINFIELD ROAD
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190
Country	:	US
Telephone Number	:	630-933-4700
Fax Number	:	630-933-4721

Provider Business Practice Location Address
First Line	:	25 N WINFIELD ROAD
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190
Country	:	US
Telephone Number	:	630-933-4700
Fax Number	:	630-933-4721

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/16/2017

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Directions to “ THOMAS A. EISEMAN M.D.” Practice Location

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