Healthcare Provider Details

I. General information

NPI: 1730185117
Provider Name (Legal Business Name): THOMAS NICHOLAS FLEMING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 N ILLINOIS ST
SWANSEA IL
62226-1919
US

IV. Provider business mailing address

3990 N ILLINOIS ST
SWANSEA IL
62226-1919
US

V. Phone/Fax

Practice location:
  • Phone: 618-277-1130
  • Fax: 618-277-4917
Mailing address:
  • Phone: 618-277-1130
  • Fax: 618-277-4917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: