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General NPI Number Information
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NPI Number | 1497793400
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Entity Type | Organization
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Legal Business Name | DIABETES THYROID AND OSTEOPOROSIS CLINIC OF SOUTHERN ILLINOIS LTD
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 1 HOLLY RIDGE CT
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City | SWANSEA
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State | IL
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Zip | 62226
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Country | US
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Telephone | 618-520-3003
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Fax | 618-277-3926
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Provider Business Mailing Address
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Address Line | 1 HOLLY RIDGE CT
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City | SWANSEA
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State | IL
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Zip | 62226-2322
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Country | US
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Telephone | 618-520-3003
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Fax | 618-277-3926
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS F TSE
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Credential | M.D.
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Telephone | 618-520-3003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 042616864
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License Number State | IL
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