Provider Demographics
NPI:1255478970
Name:CORSOLINI, THOMAS B (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:CORSOLINI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3520 S CULPEPPER CIRCLE STE. D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804
Mailing Address - Country:US
Mailing Address - Phone:417-882-7500
Mailing Address - Fax:417-881-2840
Practice Address - Street 1:3520 S CULPEPPER CIRCLE STE. D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-882-7500
Practice Address - Fax:417-881-2840
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO104716208100000X, 204R00000X, 2081P2900X, 2083P0500X, 202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206847808Medicaid
MOB52212Medicare UPIN
MO206847808Medicaid