Provider Demographics
NPI:1447288303
Name:TURCOTTE, THOMAS E JR (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:TURCOTTE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 E. 1ST ST., SUITE #315
Mailing Address - Street 2:KSB MEDICAL GROUP
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021
Mailing Address - Country:US
Mailing Address - Phone:815-285-5603
Mailing Address - Fax:815-285-5813
Practice Address - Street 1:215 E. 1ST ST., SUITE #315
Practice Address - Street 2:KSB MEDICAL GROUP
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021
Practice Address - Country:US
Practice Address - Phone:815-285-5603
Practice Address - Fax:815-285-5813
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02000967A207YX0905X
IL036.073224207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100367750AMedicaid
IND16245Medicare UPIN
473060R5Medicare PIN