Provider Demographics
NPI:1972541381
Name:THAYIL, TOM T (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:T
Last Name:THAYIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 GALAXIE ROAD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4426
Mailing Address - Country:US
Mailing Address - Phone:972-600-2223
Mailing Address - Fax:972-863-6020
Practice Address - Street 1:7502 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3802
Practice Address - Country:US
Practice Address - Phone:972-600-2223
Practice Address - Fax:972-863-6020
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX356289ZG29Medicare PIN
TX356289ZG28Medicare PIN
TX162047802Medicaid
TX8D2023Medicare PIN
TX8J5319Medicare PIN