Provider Demographics
NPI:1225305303
Name:TOM ALLEN MD SC
Entity Type:Organization
Organization Name:TOM ALLEN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-218-9316
Mailing Address - Street 1:431 W OAKDALE AVE
Mailing Address - Street 2:8C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5959
Mailing Address - Country:US
Mailing Address - Phone:312-218-9316
Mailing Address - Fax:312-578-0506
Practice Address - Street 1:333 N MICHIGAN AVE STE 1114
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-4001
Practice Address - Country:US
Practice Address - Phone:312-578-0468
Practice Address - Fax:312-578-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361114002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty