Basic Information
| Provider Information | |||||||||
| NPI: | 1134178015 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KROLICK | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2421 E SOUTHERN AVE | ||||||||
| Address2: | STE 1 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852827612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804252160 | ||||||||
| FaxNumber: | 4803518797 | ||||||||
| Practice Location | |||||||||
| Address1: | 6701 159TH ST | ||||||||
| Address2: | |||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604771758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089157400 | ||||||||
| FaxNumber: | 7084290187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 06/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 36080234 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | C30741 | 01 | IL | RR MEDICARE | OTHER |