Healthcare Provider Details

I. General information

NPI: 1497729768
Provider Name (Legal Business Name): THOMAS A CLIATT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 11/27/2023
Certification Date: 10/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 W WASHINGTON ST
PITTSFIELD IL
62363-1350
US

IV. Provider business mailing address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

V. Phone/Fax

Practice location:
  • Phone: 217-285-2113
  • Fax:
Mailing address:
  • Phone: 217-223-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number055932
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036095686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: