Healthcare Provider Details

I. General information

NPI: 1942075882
Provider Name (Legal Business Name): FASHIONED MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 630-448-2724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS CARABALLO
Title or Position: PHYSICIAN/FOUNDER
Credential: DO
Phone: 630-448-2724