Healthcare Provider Details

I. General information

NPI: 1619238086
Provider Name (Legal Business Name): TENY PHILIP THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TENY ANNA PHILIP M.D.

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 SHERMER RD
NORTHBROOK IL
60062-5317
US

IV. Provider business mailing address

9977 WOODS DR
SKOKIE IL
60077-1057
US

V. Phone/Fax

Practice location:
  • Phone: 847-272-4600
  • Fax: 847-272-4655
Mailing address:
  • Phone: 847-663-8250
  • Fax: 847-663-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036139661
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: