Provider Demographics
NPI:1144258492
Name:CALDWELL, THOMAS F (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:CALDWELL
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 1:3035 EAST MOUND ROAD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-9381
Mailing Address - Country:US
Mailing Address - Phone:217-875-2670
Mailing Address - Fax:217-875-2689
Practice Address - Street 1:3035 EAST MOUND ROAD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-9381
Practice Address - Country:US
Practice Address - Phone:217-875-2670
Practice Address - Fax:217-875-2689
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107296Medicaid
ILP00367868Medicare ID - Type UnspecifiedRR INDIVIDUAL #
IL036107296Medicaid
ILK28955Medicare ID - Type UnspecifiedINDIVIDUAL #
H91973Medicare UPIN
ILCA2182Medicare ID - Type UnspecifiedRR GROUP #