MEDICARE: TOM ALLEN MD SC

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	2084P0800X	Psychiatry Physician	036111400	IL

General Provider Information

NPI Number	:	1225305303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOM ALLEN MD SC

Provider Business Mailing Address
First Line	:	431 W OAKDALE AVE
Second Line	:	8C
City	:	CHICAGO
State	:	IL
Zip	:	60657-5959
Country	:	US
Telephone Number	:	312-218-9316
Fax Number	:	312-578-0506

Provider Business Practice Location Address
First Line	:	333 N MICHIGAN AVE STE 1114
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-4001
Country	:	US
Telephone Number	:	312-578-0468
Fax Number	:	312-578-0506

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS WILLIAM ALLEN
Credential	:	MD
Telephone Number	:	312-218-9316

Provider Enumeration Date	:	11/17/2011
Last Update Date	:	11/17/2011

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Directions to “TOM ALLEN MD SC ” Practice Location

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