Provider Demographics
NPI:1174206452
Name:RECKO, THOMAS MOORE (DNP)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MOORE
Last Name:RECKO
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 RAVINE WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7621
Mailing Address - Country:US
Mailing Address - Phone:847-832-6700
Mailing Address - Fax:847-832-9430
Practice Address - Street 1:2350 RAVINE WAY STE 400
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7621
Practice Address - Country:US
Practice Address - Phone:847-832-6700
Practice Address - Fax:847-832-9430
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.028038363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner