Provider Demographics
NPI:1184879710
Name:KEANE, THOMAS EARL (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EARL
Last Name:KEANE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E ILLINOIS ST
Mailing Address - Street 2:904
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5063
Mailing Address - Country:US
Mailing Address - Phone:443-458-2442
Mailing Address - Fax:
Practice Address - Street 1:903 COMMERCE DR
Practice Address - Street 2:SUITE 333
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1969
Practice Address - Country:US
Practice Address - Phone:443-458-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00680812085R0202X
PAMD4397542085R0204X
MDD680812085R0204X
NY2334102085R0204X
OH35.0942952085R0204X
WI777892085R0204X
IL0361269572085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00821020OtherRAIL ROAD MEDICARE
WV3810017563Medicaid
WI1184879710Medicaid
OH2998476Medicaid