Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036-114043 | IL |
N | 208600000X | Surgeon | 036-114043 | IL |
Y | 2086S0102X | Surgical Critical Care | 036114043 | IL |
NPI | 1275638504 |
---|---|
Provider Name | Dr. Yalaunda M. Thomas |
First Address | Miamisburg, OH 45342-6115 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 02/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036114043 | ILL LICENSE (01) | IL |