Provider Demographics
NPI:1033460381
Name:BLICHARSKI, TOM (APN)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:BLICHARSKI
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 W 102ND ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4223
Mailing Address - Country:US
Mailing Address - Phone:708-738-1182
Mailing Address - Fax:
Practice Address - Street 1:4701 W 102ND ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4223
Practice Address - Country:US
Practice Address - Phone:708-738-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009677364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist