MEDICARE: THOMAS F. GUTCHEWSKY APN, CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	209.002478	IL
2	363L00000X	Nurse Practitioner	209002478	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F400287719	OTHER	IL	MEDICARE PTAN

General Provider Information

NPI Number	:	1013918598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS F. GUTCHEWSKY APN, CNP

Provider Business Mailing Address
First Line	:	12251 S 80TH AVE STE 1520
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1290
Country	:	US
Telephone Number	:	708-923-4200
Fax Number	:	708-923-4201

Provider Business Practice Location Address
First Line	:	12251 S 80TH AVE STE 1520
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1290
Country	:	US
Telephone Number	:	708-923-4200
Fax Number	:	708-923-4201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	12/15/2022

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