Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016-005792 | IL |
Y | 222Z00000X | Podiatrist | 016-005792 | IL |
NPI | 1003363540 |
---|---|
Provider Name | Darla Thomas |
First Address | Chicago, IL 60625-6306 |
Second Address | Chicago, IL 60617-2740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 22/01/2020 |