Provider Demographics
NPI:1275635120
Name:PAE, THOMAS H (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:H
Last Name:PAE
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 1:880 W CENTRAL RD STE 5000
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2355
Mailing Address - Country:US
Mailing Address - Phone:847-618-3800
Mailing Address - Fax:847-618-3809
Practice Address - Street 1:880 W CENTRAL RD STE 5000
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2355
Practice Address - Country:US
Practice Address - Phone:847-618-3800
Practice Address - Fax:847-618-3809
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108506208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108506Medicaid
ILK36454Medicare ID - Type Unspecified