Physician Compare National (NPI:1629087994)

HEALTHCARE PROVIDER: THOMAS JOSEPH WILDA SOCIAL WORK, MSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1629087994
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2567556418
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070921000756
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WILDA
	Individual professional last name
Provider First Name	THOMAS
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1991
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	655 W IRVING PARK RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 202
	Group Practice or individual's line 2 address
City	CHICAGO
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	606134932
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7735288075
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y