Provider Demographics
NPI:1043208176
Name:TOMAS, PETER P (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:P
Last Name:TOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16050 S DAN OCONNELL DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-8030
Mailing Address - Country:US
Mailing Address - Phone:815-436-0329
Mailing Address - Fax:
Practice Address - Street 1:333 MADISON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8200
Practice Address - Country:US
Practice Address - Phone:815-725-7222
Practice Address - Fax:815-725-7080
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048420207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL366889700OtherUS DEPARTMENT OF LABOR - AURORA
IL036048420Medicaid
IL130765700OtherUS DEPARTMENT OF LABOR - JOLIET
IL130765700OtherUS DEPARTMENT OF LABOR - JOLIET
ILC45012Medicare UPIN