Provider Demographics
NPI:1558377069
Name:SZYMKE, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SZYMKE
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 1:5100 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:309-672-4809
Mailing Address - Fax:
Practice Address - Street 1:214 NE GLEN OAK AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-4309
Practice Address - Country:US
Practice Address - Phone:309-672-4603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360663311Medicaid
IL045465OtherHEALTH ALLIANCE
IL7215059OtherBCBS PPO
IL563097OtherHEALTHLINK
ILIL01M6OtherJOHN DEERE
ILIL01M6OtherJOHN DEERE
IL045465OtherHEALTH ALLIANCE