Healthcare Provider Details

I. General information

NPI: 1013941053
Provider Name (Legal Business Name): THOMAS BUMP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 W 95TH ST
EVERGREEN PARK IL
60805-2135
US

IV. Provider business mailing address

3545 W 95TH ST
EVERGREEN PARK IL
60805-2135
US

V. Phone/Fax

Practice location:
  • Phone: 708-346-5562
  • Fax: 708-346-2059
Mailing address:
  • Phone: 708-346-5562
  • Fax: 708-346-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036-062686
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036-062686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: