Provider Demographics
NPI:1063788107
Name:TOMMASO, LAURA HALEY (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:HALEY
Last Name:TOMMASO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10350 HALIGUS RD STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9545
Mailing Address - Country:US
Mailing Address - Phone:847-802-7500
Mailing Address - Fax:847-802-7162
Practice Address - Street 1:10350 HALIGUS RD STE A
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9545
Practice Address - Country:US
Practice Address - Phone:847-802-7500
Practice Address - Fax:847-802-7162
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125061825207Q00000X
IL036136901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine