Healthcare Provider Details

I. General information

NPI: 1013918598
Provider Name (Legal Business Name): THOMAS F. GUTCHEWSKY APN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12251 S 80TH AVE STE 1520
PALOS HEIGHTS IL
60463-1290
US

IV. Provider business mailing address

12251 S 80TH AVE STE 1520
PALOS HEIGHTS IL
60463-1290
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-4200
  • Fax: 708-923-4201
Mailing address:
  • Phone: 708-923-4200
  • Fax: 708-923-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.002478
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209002478
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: