Provider Demographics
NPI:1952505190
Name:THOMAS VALENTE M.D., P.A.
Entity Type:Organization
Organization Name:THOMAS VALENTE M.D., P.A.
Other - Org Name:THOMAS VALENTE M.D., S.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VALENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-296-4055
Mailing Address - Street 1:4200 N MARINE DR
Mailing Address - Street 2:1106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1743
Mailing Address - Country:US
Mailing Address - Phone:773-296-4055
Mailing Address - Fax:773-296-4055
Practice Address - Street 1:4200 N MARINE DR
Practice Address - Street 2:1106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1743
Practice Address - Country:US
Practice Address - Phone:773-296-4055
Practice Address - Fax:773-296-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty