Healthcare Provider Details

I. General information

NPI: 1639064710
Provider Name (Legal Business Name): THOMAS RICHEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 HARTREY AVE
EVANSTON IL
60202-1056
US

IV. Provider business mailing address

6720 N DAMEN AVE APT 1B
CHICAGO IL
60645-4978
US

V. Phone/Fax

Practice location:
  • Phone: 847-666-3494
  • Fax: 847-868-8999
Mailing address:
  • Phone: 706-814-3069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.032907
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN277604
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.589724
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: