Provider Demographics
NPI:1245322858
Name:THOMAS K DILLON MD, INC
Entity type:Organization
Organization Name:THOMAS K DILLON MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-841-9551
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-0236
Mailing Address - Country:US
Mailing Address - Phone:734-847-4565
Mailing Address - Fax:734-847-6261
Practice Address - Street 1:6591 W CENTRAL AVE
Practice Address - Street 2:STE 105
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1087
Practice Address - Country:US
Practice Address - Phone:419-841-9551
Practice Address - Fax:419-841-9634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID