Provider Demographics
NPI:1487746939
Name:PITTMAN, THOMAS LINDLEY (PA-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LINDLEY
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2940 ROLLINGRIDGE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4234
Mailing Address - Country:US
Mailing Address - Phone:630-579-6500
Mailing Address - Fax:630-495-7958
Practice Address - Street 1:2940 ROLLINGRIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4234
Practice Address - Country:US
Practice Address - Phone:630-579-6500
Practice Address - Fax:630-579-5860
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085000989363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085000989OtherSTATE