Provider Demographics
NPI:1639277551
Name:ENG, THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:ENG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 DELNOR DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4220
Mailing Address - Country:US
Mailing Address - Phone:630-262-1001
Mailing Address - Fax:630-262-8065
Practice Address - Street 1:351 DELNOR DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134
Practice Address - Country:US
Practice Address - Phone:630-262-1001
Practice Address - Fax:630-262-8065
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107598Medicaid
ILK34553OtherMEDICARE PTAN (INDIVIDUAL)
IL036107598Medicaid
IL592050Medicare ID - Type Unspecified