Provider Demographics
NPI:1114032372
Name:DWYER, THOMAS S (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:DWYER
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 1:2111 MIDLANDS CT
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3125
Mailing Address - Country:US
Mailing Address - Phone:815-758-0000
Mailing Address - Fax:815-756-7130
Practice Address - Street 1:2111 MIDLANDS CT
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3125
Practice Address - Country:US
Practice Address - Phone:815-758-0000
Practice Address - Fax:815-758-8521
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003526213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01915167OtherBLUE CROSS/BLUE SHIELD
IL016003526Medicaid
IL0359580001OtherDMERC
IL008866OtherHEALTH ALLIANCE
IL480032269OtherRAILROAD MEDICARE
IL480032269OtherRAILROAD MEDICARE
ILT38378Medicare UPIN