Provider Demographics
NPI:1225033871
Name:KAZMIERCZAK, THOMAS M JR (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:KAZMIERCZAK
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:936 W US ROUTE 6
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-8858
Practice Address - Country:US
Practice Address - Phone:815-942-0525
Practice Address - Fax:815-942-3501
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107879207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL259912OtherHEALTHLINK
IL3229984OtherBCBS
IL020438OtherHEALTH ALLIANCE
IL036107897Medicaid
ILK05950Medicare ID - Type Unspecified
IL020438OtherHEALTH ALLIANCE
IL208830Medicare ID - Type UnspecifiedGROUP