Provider Demographics
NPI:1487614210
Name:ARNDT, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:ARNDT
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 1:9921 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3767
Mailing Address - Country:US
Mailing Address - Phone:708-425-8616
Mailing Address - Fax:708-425-9468
Practice Address - Street 1:9921 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3767
Practice Address - Country:US
Practice Address - Phone:708-425-8616
Practice Address - Fax:708-425-9468
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063478207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063478Medicaid
IL1223002OtherMEDICARE PTAN INDIVIDUAL
IL1223002OtherMEDICARE PTAN INDIVIDUAL