Healthcare Provider Details

I. General information

NPI: 1558751560
Provider Name (Legal Business Name): THOMAS F CARABALLO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date: 07/13/2018
Reactivation Date: 07/18/2018

III. Provider practice location address

1325 N HIGHLAND AVE
AURORA IL
60506
US

IV. Provider business mailing address

105 S YORK ST STE 215
ELMHURST IL
60126-3463
US

V. Phone/Fax

Practice location:
  • Phone: 630-859-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.145719
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: