Provider Demographics
NPI:1134105125
Name:GARRITY, THOMAS E (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:GARRITY
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 1:6887 SEPTEMBER BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5117
Mailing Address - Country:US
Mailing Address - Phone:847-507-9293
Mailing Address - Fax:773-467-1465
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-437-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-094249207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094249Medicaid
IL036094249Medicaid
IL590010Medicare ID - Type UnspecifiedGROUP NUMBER