Provider Demographics
NPI:1467623330
Name:PATRICOSKI, THOMAS STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:STANLEY
Last Name:PATRICOSKI
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 1:9800 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3617
Mailing Address - Country:US
Mailing Address - Phone:708-229-4663
Mailing Address - Fax:708-499-5975
Practice Address - Street 1:9800 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3617
Practice Address - Country:US
Practice Address - Phone:708-229-4663
Practice Address - Fax:708-499-5975
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLL660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036039140OtherMEDICARE NUMBER
IL036039140OtherMEDICARE NUMBER