Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036.135378 | IL |
NPI | 1134359862 |
---|---|
Provider Name | Amy O'brian Thomas |
First Address | Gurnee, IL 60031-1651 |
Second Address | Gurnee, IL 60031-1651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 05/04/2021 |