Organization
THOMAS N PORTER MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS N PORTER MD (PHYSICIAN, PRESIDENT)
(847) 367-1151
Entity
Organization
Contact information
Practice address
755 S MILWAUKEE AVE, STE 263, LIBERTYVILLE, IL 60048-3266
(847) 367-1151
(847) 367-8729
Mailing address
755 S MILWAUKEE AVE, STE 263, LIBERTYVILLE, IL 60048-3266
(847) 367-1151
(847) 367-8729
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04915342
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/17/2007
Last updated
10/17/2007
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