Provider Demographics
NPI:1083602718
Name:NOLEN, THOMAS H (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:NOLEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-1403
Mailing Address - Country:US
Mailing Address - Phone:618-548-0057
Mailing Address - Fax:618-548-9611
Practice Address - Street 1:624 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-1403
Practice Address - Country:US
Practice Address - Phone:618-548-0057
Practice Address - Fax:618-548-9611
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004182213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL135686OtherHEALTHLINK
IL60115194OtherBCBS, MTVERNON, IL OFFIC
IL016004182Medicaid
IL6106002OtherBCBS, SALEM, IL OFFICE
IL6106004OtherBCBS, CENTRALIA, IL OF
IL787810Medicare PIN
IL135686OtherHEALTHLINK
IL0491040001Medicare NSC
IL6106004OtherBCBS, CENTRALIA, IL OF
IL016004182Medicaid
IL480025561Medicare PIN
IL60115194OtherBCBS, MTVERNON, IL OFFIC
IL0491040002Medicare NSC
IL787812Medicare PIN
IL480025173Medicare PIN