Individual
DR. THOMAS J VASDEKAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12701 W 143RD ST, HOMER GLEN, IL 60491-7715
(815) 300-7764
Mailing address
12701 W 143RD ST, HOMER GLEN, IL 60491-7715
(815) 300-7764
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036068616
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020016372
PALMETTO RR MEDICARE
IL
05
—
036068616
—
IL
01
—
31604034
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/20/2006
Last updated
08/27/2024
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