Provider Demographics
NPI:1487878369
Name:DR. TJ KEHOE, LTD
Entity type:Organization
Organization Name:DR. TJ KEHOE, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEHOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-111-0000
Mailing Address - Street 1:5210 CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-7901
Mailing Address - Country:US
Mailing Address - Phone:847-777-0000
Mailing Address - Fax:847-465-3403
Practice Address - Street 1:5210 CAPITOL DR
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-7901
Practice Address - Country:US
Practice Address - Phone:847-777-0000
Practice Address - Fax:847-465-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC43575Medicare UPIN