Provider Demographics
NPI:1275630253
Name:VASDEKAS, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:VASDEKAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10660 W 143RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1989
Mailing Address - Country:US
Mailing Address - Phone:708-349-0055
Mailing Address - Fax:708-460-8031
Practice Address - Street 1:15300 WEST AVE STE 202
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4683
Practice Address - Country:US
Practice Address - Phone:708-349-0055
Practice Address - Fax:708-460-8031
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068616208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL020016372OtherPALMETTO RR MEDICARE
IL31604034OtherBLUE CROSS BLUE SHIELD
IL036068616Medicaid
IL036068616Medicaid
IL954760Medicare PIN