MEDICARE: THOMAS H FENDON M.D.

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	2086S0122X	Plastic and Reconstructive Surgery Physician	036074699	IL

General Provider Information

NPI Number	:	1225124910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS H FENDON M.D.

Provider Business Mailing Address
First Line	:	901 CENTER ST
Second Line	:	SUITE 3002
City	:	ELGIN
State	:	IL
Zip	:	60120-2104
Country	:	US
Telephone Number	:	847-531-6340
Fax Number	:	847-531-6344

Provider Business Practice Location Address
First Line	:	901 CENTER ST
Second Line	:	SUITE 3002
City	:	ELGIN
State	:	IL
Zip	:	60120-2104
Country	:	US
Telephone Number	:	847-531-6340
Fax Number	:	847-531-6344

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	08/12/2011

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Directions to “ THOMAS H FENDON M.D.” Practice Location

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