Provider Demographics
NPI:1649317835
Name:REBORI, THOMAS ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANTHONY
Last Name:REBORI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4525 N RAVENSWOOD AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5201
Mailing Address - Country:US
Mailing Address - Phone:312-857-8794
Mailing Address - Fax:708-575-8311
Practice Address - Street 1:1200 SHERMER RD
Practice Address - Street 2:SUITE 208
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4500
Practice Address - Country:US
Practice Address - Phone:847-480-0131
Practice Address - Fax:847-686-0134
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2022-07-26
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Provider Licenses
StateLicense IDTaxonomies
COCDR.00012362084P0800X
AZ645682084P0800X
IL0360863122084P0800X
GA912902084P0800X
TXT89242084P0800X
NCFR18303652084P0800X
NC2022-017822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE83116Medicare UPIN