Individual
DR. THOMAS A WIDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 S CALIFORNIA AVE, CHICAGO, IL 60608
(773) 257-6843
Mailing address
3537 PAYSPHERE CIR, CHICAGO, IL 60674-0035
(708) 786-2900
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036084421
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-084421-2
—
IL
Enumeration date
07/29/2005
Last updated
08/21/2018
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