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NPI Code Detail

MEDICARE: MR. THOMAS S HANS JR. PA-C

MEDICARE: MR. THOMAS S HANS JR. PA-C
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
1363A00000XPhysician Assistant085004254IL

General Provider Information

NPI Number : 1750369914
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS S HANS JR. PA-C
Provider Business Mailing Address
First Line : PO BOX 735263
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5263
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5875 E RIVERSIDE BLVD
Second Line :
City : ROCKFORD
State : IL
Zip : 61114-4937
Country : US
Telephone Number : 815-398-9491
Fax Number : 815-381-7498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 10/12/2023

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