Provider Demographics
NPI:1285804070
Name:DR. THOMAS V. TSOUTSOURIS
Entity type:Organization
Organization Name:DR. THOMAS V. TSOUTSOURIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:TSOUTSOURIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-844-2020
Mailing Address - Street 1:7330 INDIANAPOLIS BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-2945
Mailing Address - Country:US
Mailing Address - Phone:219-844-2020
Mailing Address - Fax:
Practice Address - Street 1:7330 INDIANAPOLIS BLVD STE 3
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2945
Practice Address - Country:US
Practice Address - Phone:219-844-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
388020Medicare PIN