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NPI Code Detail

MEDICARE: DR. THOMAS EDWIN KLARQUIST M.D.

MEDICARE: DR. THOMAS EDWIN KLARQUIST 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
1207R00000XInternal Medicine Physician036100647IL

General Provider Information

NPI Number : 1477517373
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS EDWIN KLARQUIST M.D.
Provider Business Mailing Address
First Line : 29373 NETWORK PL
Second Line :
City : CHICAGO
State : IL
Zip : 60673-1293
Country : US
Telephone Number : 847-390-5900
Fax Number :
Provider Business Practice Location Address
First Line : 3134 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4414
Country : US
Telephone Number : 773-296-5090
Fax Number : 312-766-4908
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2006
Last Update Date : 03/26/2025

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