Healthcare Provider Details

I. General information

NPI: 1962872200
Provider Name (Legal Business Name): THOMAS JOSEPH AHEARN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27650 FERRY RD STE 110
WARRENVILLE IL
60555-3846
US

IV. Provider business mailing address

27650 FERRY RD STE 110
WARRENVILLE IL
60555-3846
US

V. Phone/Fax

Practice location:
  • Phone: 630-315-6543
  • Fax: 630-315-6537
Mailing address:
  • Phone: 630-315-6543
  • Fax: 630-315-6537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006089
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1128403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: