Provider Demographics
NPI:1487831541
Name:TOMCZAK, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:TOMCZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16700 ANNE MARIE DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2996
Mailing Address - Country:US
Mailing Address - Phone:708-429-4860
Mailing Address - Fax:
Practice Address - Street 1:16700 ANNE MARIE DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2996
Practice Address - Country:US
Practice Address - Phone:708-429-4860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator