Healthcare Provider Details

I. General information

NPI: 1336148790
Provider Name (Legal Business Name): THOMAS PAINTER MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S DRYDEN PL
ARLINGTON HEIGHTS IL
60004-6369
US

IV. Provider business mailing address

520 E 22ND ST
LOMBARD IL
60148-6110
US

V. Phone/Fax

Practice location:
  • Phone: 847-577-5814
  • Fax:
Mailing address:
  • Phone: 630-874-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS A. PAINTER
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 847-577-5814