MEDICARE: DR. THOMAS A AMBROSE II MD

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	207X00000X	Orthopaedic Surgery Physician	01037487A	IN
2	207X00000X	Orthopaedic Surgery Physician	41335	IA
3	207X00000X	Orthopaedic Surgery Physician	10090	SD
4	207X00000X	Orthopaedic Surgery Physician	036172356	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000247026	OTHER	IN	ANTHEM PIN

General Provider Information

NPI Number	:	1679524805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS A AMBROSE II MD

Provider Business Mailing Address
First Line	:	900 W TEMPLE AVE STE 2500
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-2121
Country	:	US
Telephone Number	:	217-540-2350
Fax Number	:	217-347-2323

Provider Business Practice Location Address
First Line	:	900 W TEMPLE AVE STE 2500
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-2121
Country	:	US
Telephone Number	:	217-540-2350
Fax Number	:	217-347-2323

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	01/15/2025

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Directions to “ DR. THOMAS A AMBROSE II MD” Practice Location

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