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NPI Code Detail

MEDICARE: THOMAS ANDREW EHMKE D.O.

MEDICARE: THOMAS ANDREW EHMKE D.O.
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
1207XS0114XAdult Reconstructive Orthopaedic Surgery Physician036.138530IL
2207X00000XOrthopaedic Surgery Physician036138530IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
102005258AOTHERININDIANA DO LICENSE
2036.138530OTHERILSTATE LICENSE

General Provider Information

NPI Number : 1861703233
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS ANDREW EHMKE D.O.
Provider Business Mailing Address
First Line : 4700 GILBERT AVE
Second Line : STE 52
City : WESTERN SPRINGS
State : IL
Zip : 60558-1753
Country : US
Telephone Number : 708-387-1737
Fax Number : 708-387-1739
Provider Business Practice Location Address
First Line : 4700 GILBERT AVE STE 51
Second Line :
City : WESTERN SPRINGS
State : IL
Zip : 60558-1664
Country : US
Telephone Number : 708-387-1737
Fax Number : 630-387-1739
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2010
Last Update Date : 01/06/2020

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