Provider Demographics
NPI:1851687453
Name:IANNUCCI, THOMAS M (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:IANNUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16532 GARNET COURT
Mailing Address - Street 2:ORLAND PARK
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467
Mailing Address - Country:US
Mailing Address - Phone:708-226-1273
Mailing Address - Fax:708-226-1274
Practice Address - Street 1:16532 GARNET COURT
Practice Address - Street 2:ORLAND PARK
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:708-226-1273
Practice Address - Fax:708-226-1274
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.035492207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology