Provider Demographics
NPI:1275534406
Name:CARMODY, THOMAS PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PATRICK
Last Name:CARMODY
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:PO BOX 95279
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60694-5279
Mailing Address - Country:US
Mailing Address - Phone:877-485-4474
Mailing Address - Fax:
Practice Address - Street 1:3815 HIGHLAND AVE
Practice Address - Street 2:ADVOCATE GOOD SAMARITAN HOSPITAL
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1500
Practice Address - Country:US
Practice Address - Phone:630-275-5900
Practice Address - Fax:630-734-1560
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-099110207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099110Medicaid
ILL71907Medicare ID - Type Unspecified