Provider Demographics
NPI:1417934639
Name:PREDEY, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:PREDEY
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 1:3228 COTUIT LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-9811
Mailing Address - Country:US
Mailing Address - Phone:630-885-2100
Mailing Address - Fax:630-922-5989
Practice Address - Street 1:3228 COTUIT LN
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-9811
Practice Address - Country:US
Practice Address - Phone:630-885-2100
Practice Address - Fax:630-922-5989
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360715242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL300093502OtherRAILROAD MEDICARE
IL036071524Medicaid
IL1316998578OtherIHAV-NPI GROUP PRACTICE
IL1376728105OtherNPI NEW CORP