Healthcare Provider Details

I. General information

NPI: 1871840579
Provider Name (Legal Business Name): THOMAS L. HESSELINK MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 BURR RIDGE PKWY
BURR RIDGE IL
60527-6485
US

IV. Provider business mailing address

322 BURR RIDGE PKWY
BURR RIDGE IL
60527-6485
US

V. Phone/Fax

Practice location:
  • Phone: 630-321-9010
  • Fax: 630-321-9018
Mailing address:
  • Phone: 630-321-9010
  • Fax: 630-321-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036055735
License Number StateIL

VIII. Authorized Official

Name: DR. THOMAS LEE HESSELINK
Title or Position: PRESIDENT
Credential: MD
Phone: 630-321-9010