Provider Demographics
NPI:1033373717
Name:ORYSZCZAK, THOMAS RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RICHARD
Last Name:ORYSZCZAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2349
Mailing Address - Country:US
Mailing Address - Phone:847-227-8987
Mailing Address - Fax:847-618-3259
Practice Address - Street 1:800 W CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2349
Practice Address - Country:US
Practice Address - Phone:847-227-8987
Practice Address - Fax:847-618-3259
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125054828207R00000X
IL03612701208M00000X
IL036127001208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036127001OtherMEDICAID
IL206147OtherMEDICARE PTAN (GROUP)
ILF400136372OtherMEDICARE PTAN (INDIVIDUAL)