Healthcare Provider Details

I. General information

NPI: 1912094483
Provider Name (Legal Business Name): THOMAS J FUREY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 S WILLOW SPRINGS RD STE 490
LAGRANGE IL
60525
US

IV. Provider business mailing address

5201 S WILLOW SPRINGS RD STE 490
LAGRANGE IL
60525
US

V. Phone/Fax

Practice location:
  • Phone: 708-352-4630
  • Fax: 708-352-8348
Mailing address:
  • Phone: 708-352-4630
  • Fax: 708-352-8348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: