Provider Demographics
NPI:1225124910
Name:FENDON, THOMAS H (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:FENDON
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 1:901 CENTER ST
Mailing Address - Street 2:SUITE 3002
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-2104
Mailing Address - Country:US
Mailing Address - Phone:847-531-6340
Mailing Address - Fax:847-531-6344
Practice Address - Street 1:901 CENTER ST
Practice Address - Street 2:SUITE 3002
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-2104
Practice Address - Country:US
Practice Address - Phone:847-531-6340
Practice Address - Fax:847-531-6344
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360746992086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery