Individual
MR. THOMAS GAVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CO/LO
Contact information
Practice address
1010 JORIE BLVD STE 24, OAK BROOK, IL 60523-4450
(630) 573-7777
(630) 573-4424
Mailing address
1010 JORIE BLVD STE 24, OAK BROOK, IL 60523-4450
(630) 573-7777
(630) 573-4424
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
04/16/2019
Last updated
04/16/2019
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