Provider Demographics
NPI:1235132952
Name:KANNIN, THOMAS F (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:KANNIN
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 1:6954 W TOUHY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4535
Mailing Address - Country:US
Mailing Address - Phone:847-647-1771
Mailing Address - Fax:847-647-5981
Practice Address - Street 1:6954 W TOUHY AVE STE 101
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4535
Practice Address - Country:US
Practice Address - Phone:847-647-1771
Practice Address - Fax:847-647-5981
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086448Medicaid
IL745369Medicare ID - Type Unspecified
IL036086448Medicaid