| Thomas Undine | |
|
410 S Michigan Ave Ste 943 Chicago IL 60605-1399 | |
| (773) 732-7700 | |
| (773) 304-3517 |
| Full Name | Thomas Undine |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 410 S Michigan Ave Ste 943, Chicago, Illinois |
| Authorized Official Name and Position | Thomas R Undine (FOUNDING THERAPIST) |
| Authorized Official Contact | 7737327700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas Undine 410 S Michigan Ave Ste 943 Chicago IL 60605-1399 Ph: (773) 732-7700 | Thomas Undine 410 S Michigan Ave Ste 943 Chicago IL 60605-1399 Ph: (773) 732-7700 |
| NPI Number | 1366823585 |
|---|---|
| Provider Enumeration Date | 06/12/2015 |
| Last Update Date | 06/12/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366823585 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149.013059 (Illinois) | Primary |
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