MEDICARE: DR. THOMAS T BAHK MD

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	207P00000X	Emergency Medicine Physician		IL

General Provider Information

NPI Number	:	1710912365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS T BAHK MD

Provider Business Mailing Address
First Line	:	1S326 MARYS LN
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-4605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8012 S CRANDON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-1124
Country	:	US
Telephone Number	:	773-356-5331
Fax Number	:	773-768-8154

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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