Healthcare Provider Details

I. General information

NPI: 1407856073
Provider Name (Legal Business Name): THOMAS MICHAEL HOELTGEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 09/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST SUITE 311
OAK LAWN IL
60453-2654
US

IV. Provider business mailing address

4400 W 95TH ST SUITE 311
OAK LAWN IL
60453-2654
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-9710
  • Fax: 708-424-4331
Mailing address:
  • Phone: 708-424-9710
  • Fax: 708-424-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number036-041362
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: