Healthcare Provider Details

I. General information

NPI: 1801013057
Provider Name (Legal Business Name): THOMAS J. BOYSEN, D.P.M., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16325 HARLEM AVE SUITE 100
TINLEY PARK IL
60477-2509
US

IV. Provider business mailing address

16325 HARLEM AVE SUITE 100
TINLEY PARK IL
60477-2509
US

V. Phone/Fax

Practice location:
  • Phone: 708-444-0646
  • Fax: 708-444-1506
Mailing address:
  • Phone: 708-444-0646
  • Fax: 708-444-1506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number016002685
License Number StateIL

VIII. Authorized Official

Name: DR. THOMAS JAMES BOYSEN
Title or Position: OWNER
Credential: D.P.M.
Phone: 708-444-0646