Provider Demographics
NPI:1659594430
Name:DR. THOMAS S FLACH AND ASSOCIATES
Entity Type:Organization
Organization Name:DR. THOMAS S FLACH AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:FLACH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-246-4376
Mailing Address - Street 1:512 HILLGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1442
Mailing Address - Country:US
Mailing Address - Phone:708-246-4376
Mailing Address - Fax:708-246-2912
Practice Address - Street 1:512 HILLGROVE AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1442
Practice Address - Country:US
Practice Address - Phone:708-246-4376
Practice Address - Fax:708-246-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082941Medicaid
IL036082941Medicaid
IL499520Medicare PIN