Healthcare Provider Details

I. General information

NPI: 1073683637
Provider Name (Legal Business Name): THOMAS H. NOLEN, D.P.M.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W MAIN ST
SALEM IL
62881-1403
US

IV. Provider business mailing address

624 W MAIN ST
SALEM IL
62881-1403
US

V. Phone/Fax

Practice location:
  • Phone: 618-548-0057
  • Fax: 618-548-9611
Mailing address:
  • Phone: 618-548-0057
  • Fax: 618-548-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016-004182
License Number StateIL

VIII. Authorized Official

Name: DR. THOMAS H. NOLEN
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 618-548-0057