Provider Demographics
NPI:1437109816
Name:ANDERSON, THOMAS MCDOWELL (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MCDOWELL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HOLLISTER DRIVE
Mailing Address - Street 2:SUITE G-18
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5264
Mailing Address - Country:US
Mailing Address - Phone:847-918-1462
Mailing Address - Fax:847-968-4311
Practice Address - Street 1:1800 HOLLISTER DRIVE
Practice Address - Street 2:SUITE G-18
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5264
Practice Address - Country:US
Practice Address - Phone:847-918-1462
Practice Address - Fax:847-968-4311
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0900332085R0202X, 2085R0202X
IN01060007A2085R0202X
IL036-0445422085R0202X
WI46433-0202085R0202X
WV228642085R0202X
VA01012423262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036044542Medicaid
WI34634500Medicaid
ILK06059Medicare PIN
ILL93770Medicare PIN
ILK22458Medicare PIN
ILK46405Medicare PIN
IL300137127Medicare PIN
IL300084900Medicare PIN
ILC42976Medicare UPIN
WI34634500Medicaid
IL036044542Medicaid