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General NPI Number Information
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NPI Number | 1306933320
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Entity Type | Individual
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Provider Name | THOMAS STEPHEN FLACH DO
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 512 HILLGROVE AVE
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558
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Country | US
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Telephone | 708-246-4376
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Fax | 708-246-2912
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Provider Business Mailing Address
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Address Line | 512 HILLGROVE AVE
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558
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Country | US
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Telephone | 708-246-4376
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Fax | 708-246-2912
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036082941
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License Number State | IL
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