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General NPI Number Information
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NPI Number | 1770599797
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Entity Type | Individual
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Provider Name | THOMAS I JOSEPH MD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 4736 CAL SAG RD STE A
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City | CRESTWOOD
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State | IL
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Zip | 60418-1423
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Country | US
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Telephone | 312-421-1016
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Fax | 708-390-7001
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Provider Business Mailing Address
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Address Line | 4736 CAL SAG RD STE A
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City | CRESTWOOD
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State | IL
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Zip | 60418-1423
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Country | US
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Telephone | 312-421-1016
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Fax | 708-390-7001
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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 | 036124271
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License Number State | IL
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