Provider Demographics
NPI:1093867921
Name:PAWLOWSKI, THOMAS B (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:PAWLOWSKI
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 1:2003 W FULTON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2365
Mailing Address - Country:US
Mailing Address - Phone:773-292-4800
Mailing Address - Fax:
Practice Address - Street 1:2003 W FULTON ST STE 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2365
Practice Address - Country:US
Practice Address - Phone:773-342-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-061042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-061042OtherLIC PHY AND SURGEON
IL36-061042OtherLIC PHY AND SURGEON