Healthcare Provider Details

I. General information

NPI: 1215089982
Provider Name (Legal Business Name): THOMAS A DEUTSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST SUITE 918
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

1725 W. HARRISON ST SUITE 918
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-2734
  • Fax: 312-942-2156
Mailing address:
  • Phone: 312-942-2734
  • Fax: 312-942-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036 060490
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: