Provider Demographics
NPI:1891955233
Name:WILL, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:WILL
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 1:5201 S. WILLOW SPRINGS RD.
Mailing Address - Street 2:SUITE 380
Mailing Address - City:LAGRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6439
Mailing Address - Country:US
Mailing Address - Phone:708-354-2550
Mailing Address - Fax:708-354-4552
Practice Address - Street 1:5201 S. WILLOW SPRINGS RD.
Practice Address - Street 2:SUITE 380
Practice Address - City:LAGRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6439
Practice Address - Country:US
Practice Address - Phone:708-354-2550
Practice Address - Fax:708-354-4552
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116363208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
214706024Medicare PIN
IL212549001Medicare PIN