Provider Demographics
NPI:1497793400
Name:DIABETES THYROID AND OSTEOPOROSIS CLINIC OF SOUTHERN ILLINOIS LTD
Entity Type:Organization
Organization Name:DIABETES THYROID AND OSTEOPOROSIS CLINIC OF SOUTHERN ILLINOIS LTD
Other - Org Name:THOMAS F TSE MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:TSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-520-3003
Mailing Address - Street 1:1 HOLLY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2322
Mailing Address - Country:US
Mailing Address - Phone:618-520-3003
Mailing Address - Fax:618-277-3926
Practice Address - Street 1:1 HOLLY RIDGE CT
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-520-3003
Practice Address - Fax:618-277-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042616864207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty