Healthcare Provider Details

I. General information

NPI: 1760484778
Provider Name (Legal Business Name): THOMAS F TSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOLLY RIDGE CT
SWANSEA IL
62226
US

IV. Provider business mailing address

1 HOLLY RIDGE CT
SWANSEA IL
62226-2322
US

V. Phone/Fax

Practice location:
  • Phone: 618-520-3003
  • Fax: 618-277-3926
Mailing address:
  • Phone: 618-520-3372
  • Fax: 618-277-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036061129
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: