Provider Demographics
NPI:1912957176
Name:ARMISTEAD, THOMAS ALAN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:ARMISTEAD
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 1:1726 W GLENLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2582
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4444 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2023
Practice Address - Country:US
Practice Address - Phone:773-286-0668
Practice Address - Fax:773-286-0554
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG43213Medicare UPIN
ILP00276611Medicare PIN
ILK45830Medicare PIN
ILK18203Medicare PIN