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NPI Code Detail

MEDICARE: THOMAS F. GUTCHEWSKY APN, CNP

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
1363LA2100XAcute Care Nurse Practitioner209.002478IL
2363L00000XNurse Practitioner209002478IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1F400287719OTHERILMEDICARE 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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