Provider Demographics
NPI:1073706685
Name:THOMAS H BURNSTINE, M.D.,S.C.
Entity Type:Organization
Organization Name:THOMAS H BURNSTINE, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:BURNSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-628-1256
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0187
Mailing Address - Country:US
Mailing Address - Phone:224-628-1256
Mailing Address - Fax:
Practice Address - Street 1:755 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3253
Practice Address - Country:US
Practice Address - Phone:847-816-0500
Practice Address - Fax:847-816-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079533174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty