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General NPI Number Information
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NPI Number | 1225305303
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Entity Type | Organization
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Legal Business Name | TOM ALLEN MD SC
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 333 N MICHIGAN AVE STE 1114
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City | CHICAGO
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State | IL
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Zip | 60601-4001
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Country | US
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Telephone | 312-578-0468
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Fax | 312-578-0506
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Provider Business Mailing Address
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Address Line | 431 W OAKDALE AVE 8C
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City | CHICAGO
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State | IL
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Zip | 60657-5959
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Country | US
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Telephone | 312-218-9316
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Fax | 312-578-0506
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS WILLIAM ALLEN
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Credential | MD
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Telephone | 312-218-9316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036111400
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License Number State | IL
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