MEDICARE: THOMAS I JOSEPH 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	207Q00000X	Family Medicine Physician	036124271	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

General Provider Information

NPI Number	:	1770599797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS I JOSEPH MD

Provider Business Mailing Address
First Line	:	4736 CAL SAG RD STE A
Second Line	:
City	:	CRESTWOOD
State	:	IL
Zip	:	60418-1423
Country	:	US
Telephone Number	:	312-421-1016
Fax Number	:	708-390-7001

Provider Business Practice Location Address
First Line	:	4736 CAL SAG RD STE A
Second Line	:
City	:	CRESTWOOD
State	:	IL
Zip	:	60418-1423
Country	:	US
Telephone Number	:	312-421-1016
Fax Number	:	708-390-7001

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	05/08/2024

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Directions to “ THOMAS I JOSEPH MD” Practice Location

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