Provider Demographics
NPI:1861703233
Name:EHMKE, THOMAS ANDREW (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:EHMKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:T.
Other - Middle Name:ANDREW
Other - Last Name:EHMKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:4700 GILBERT AVE
Mailing Address - Street 2:STE 52
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1753
Mailing Address - Country:US
Mailing Address - Phone:708-387-1737
Mailing Address - Fax:708-387-1739
Practice Address - Street 1:4700 GILBERT AVE STE 51
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1664
Practice Address - Country:US
Practice Address - Phone:708-387-1737
Practice Address - Fax:630-387-1739
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.138530207XS0114X
IL036138530207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02005258AOtherINDIANA DO LICENSE
IL036.138530OtherSTATE LICENSE
IL036.138530OtherSTATE LICENSE