Healthcare Provider Details

I. General information

NPI: 1447288303
Provider Name (Legal Business Name): THOMAS E. TURCOTTE JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E. 1ST ST., SUITE #315 KSB MEDICAL GROUP
DIXON IL
61021
US

IV. Provider business mailing address

215 E. 1ST ST., SUITE #315 KSB MEDICAL GROUP
DIXON IL
61021
US

V. Phone/Fax

Practice location:
  • Phone: 815-285-5603
  • Fax: 815-285-5813
Mailing address:
  • Phone: 815-285-5603
  • Fax: 815-285-5813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number02000967A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number036.073224
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: