Individual
THOMAS F MIENTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
660 N WESTMORELAND, LAKE FOREST HOSPITAL, LAKE FOREST, IL 60045-1696
(847) 234-0049
(847) 234-1946
Mailing address
75 REMITTANCE DR, STE 1895, CHICAGO, IL 60675-1895
(847) 234-0049
(847) 234-1946
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036084906
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360849066
—
IL
01
—
220021761
RR MCR
IL
Enumeration date
03/14/2006
Last updated
10/07/2014
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