Provider Demographics
NPI:1346349974
Name:THOMAS J HABERKAMP M D S C
Entity Type:Organization
Organization Name:THOMAS J HABERKAMP M D S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HABERKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-942-9980
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 938
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-9980
Practice Address - Fax:312-942-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDC3075OtherRAILROAD MEDICARE
IL9190424OtherADVOCATE HLTH PARTNERS
IL1627261OtherBCBS PROVIDER ID
IL209489Medicare ID - Type UnspecifiedCOOK CO
ILDC3075OtherRAILROAD MEDICARE