MEDICARE: DR. THOMAS E BLEASDALE 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	207R00000X	Internal Medicine Physician	036-104677	IL

General Provider Information

NPI Number	:	1366443731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS E BLEASDALE M.D.

Provider Business Mailing Address
First Line	:	5999 NEW WILKE RD
Second Line	:	SUITE 200, BLDG 2
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-4506
Country	:	US
Telephone Number	:	847-255-7107
Fax Number	:	847-255-7031

Provider Business Practice Location Address
First Line	:	5999 NEW WILKE RD
Second Line	:	SUITE 200, BLDG 2
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-4506
Country	:	US
Telephone Number	:	847-255-7107
Fax Number	:	847-255-7031

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	04/26/2021

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