Provider Demographics
NPI:1235472820
Name:KWAK, TOMMY (MD)
Entity type:Individual
Prefix:
First Name:TOMMY
Middle Name:
Last Name:KWAK
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 1:270 CENTER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1564
Mailing Address - Country:US
Mailing Address - Phone:847-200-1002
Mailing Address - Fax:224-298-0432
Practice Address - Street 1:270 CENTER DR STE 120
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1564
Practice Address - Country:US
Practice Address - Phone:847-200-1002
Practice Address - Fax:224-298-0432
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036139684208M00000X
IL036.139684207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036139684OtherSTATE LICENSE
IL036139684OtherSTATE LICENSE