Provider Demographics
NPI:1841214368
Name:THOMAS L. MICHALSEN DO LTD
Entity Type:Organization
Organization Name:THOMAS L. MICHALSEN DO LTD
Other - Org Name:D/B/A KIRKLAND MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MICHALSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:815-522-3301
Mailing Address - Street 1:406 SOUTH 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60146
Mailing Address - Country:US
Mailing Address - Phone:815-522-3301
Mailing Address - Fax:815-522-3855
Practice Address - Street 1:406 SOUTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:IL
Practice Address - Zip Code:60146
Practice Address - Country:US
Practice Address - Phone:815-522-3301
Practice Address - Fax:815-522-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096167207Q00000X
IL036066772208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42327Medicare UPIN
IL204253Medicare ID - Type Unspecified