MEDICARE: DR. THOMAS BURNSTINE 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	2084N0400X	Neurology Physician	3679533	IL

General Provider Information

NPI Number	:	1598759680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS BURNSTINE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 187
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60065-0187
Country	:	US
Telephone Number	:	847-968-5700
Fax Number	:	847-816-3212

Provider Business Practice Location Address
First Line	:	755 S MILWAUKEE AVE
Second Line	:	SUITE 220
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3253
Country	:	US
Telephone Number	:	847-816-0500
Fax Number	:	847-816-3212

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	04/20/2022

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