Individual
MR. THOMAS A MAIBENCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 E DOWNING ST STE 101, TAHLEQUAH, OK 74464-3354
(918) 453-1234
Mailing address
916 TALON DRIVE, SUITE 102, OFALLON, IL 62269-1848
(618) 628-8211
(618) 628-0883
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
336078668
IL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
35295
OK
Other
Enumeration date
02/12/2007
Last updated
03/10/2020
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