Individual
MR. THOMAS L BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
7850 W COLLEGE DR, PALOS HEIGHTS, IL 60463-1010
(708) 361-6990
(708) 361-7697
Mailing address
3037 FRESNO LN, HOMEWOOD, IL 60430-2840
(708) 957-9121
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-005729
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209005729
—
IL
01
—
P00792110
RR MEDICARE PTAN
IL
Enumeration date
07/28/2006
Last updated
09/13/2016
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