Individual
THOMAS DENNISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1850 GATEWAY DR, SYCAMORE, IL 60178-3192
(815) 758-8671
Mailing address
1850 GATEWAY DR, SYCAMORE, IL 60178-3192
(815) 758-8671
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036-065089
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008451
HEALTH ALLIANCE
IL
05
—
036065089
—
IL
Enumeration date
08/05/2006
Last updated
09/10/2012
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