Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 125.064449 | IL |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 036.143418 | IL |
NPI | 1255746376 |
---|---|
Provider Name | Dr. Nimmy Thomas Thakolkaran |
First Address | Chicago, IL 60612-3862 |
Second Address | Chicago, IL 60612-3862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2014 |
Last Update Date | 17/03/2018 |