Provider Demographics
NPI:1265659825
Name:F G TOMASIK MD, FACOG & ASSOCIATES, SC
Entity type:Organization
Organization Name:F G TOMASIK MD, FACOG & ASSOCIATES, SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:COLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:LOMBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, RMM, CPC
Authorized Official - Phone:815-725-0350
Mailing Address - Street 1:3077 W JEFFERSON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5262
Mailing Address - Country:US
Mailing Address - Phone:815-725-0350
Mailing Address - Fax:815-725-0967
Practice Address - Street 1:3077 W JEFFERSON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5262
Practice Address - Country:US
Practice Address - Phone:815-725-0350
Practice Address - Fax:815-725-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042618483261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL566420Medicare PIN