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NPI Code Detail

MEDICARE: RICHARD TOM M.D.

MEDICARE: RICHARD TOM 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
1207V00000XObstetrics & Gynecology Physician036-097522IL

General Provider Information

NPI Number : 1952396517
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD TOM M.D.
Provider Business Mailing Address
First Line : 2020 OGDEN AVE STE 400
Second Line :
City : AURORA
State : IL
Zip : 60504-5898
Country : US
Telephone Number : 630-692-5564
Fax Number : 630-692-5563
Provider Business Practice Location Address
First Line : 2020 OGDEN AVE
Second Line : SUITE 225
City : AURORA
State : IL
Zip : 60504-5894
Country : US
Telephone Number : 630-978-4800
Fax Number : 630-978-6791
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 07/21/2020

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