1073514220 NPI number — THOMAS P. KING M.D.

Table of content: THOMAS P. KING M.D. (NPI 1073514220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073514220 NPI number — THOMAS P. KING M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
THOMAS
Provider Middle Name:
P.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073514220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 S ILLINOIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VILLA PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60181-2922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-832-9510
Provider Business Mailing Address Fax Number:
630-874-2642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 BERTEAU
Provider Second Line Business Practice Location Address:
ELMHURST MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-941-4540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)