Provider Demographics
NPI:1144206012
Name:MEYER, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:MEYER
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 1:22285N PEPPER RD 111
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2539
Mailing Address - Country:US
Mailing Address - Phone:847-382-7330
Mailing Address - Fax:847-382-9654
Practice Address - Street 1:22N285 PEPPER RD
Practice Address - Street 2:SUITE #111
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5982
Practice Address - Country:US
Practice Address - Phone:847-382-7330
Practice Address - Fax:847-382-9654
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-064210207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50702OtherADVOCATE PHO
IL036064210Medicaid
IL160019097OtherRAILROAD MEDICARE
IL036064210OtherBLUE CROSS BLUE SHIELD
IL036064210Medicaid
IL160019097OtherRAILROAD MEDICARE
IL50702OtherADVOCATE PHO