Provider Demographics
NPI:1306972112
Name:TOMECKI, GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:TOMECKI
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 1:8905 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513
Mailing Address - Country:US
Mailing Address - Phone:708-387-7000
Mailing Address - Fax:708-387-7001
Practice Address - Street 1:8905 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513
Practice Address - Country:US
Practice Address - Phone:708-387-7000
Practice Address - Fax:708-387-7001
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-111748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635291OtherBLUE CROSS BLUE SHIELD
IL211506Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER