Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036068845 | IL |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036068845 | IL |
NPI | 1477504579 |
---|---|
Provider Name | Joseph S Thomas |
First Address | Chicago, IL 60643-1723 |
Second Address | Chicago, IL 60643-1723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 09/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036068845 | (05) | IL |
14D881319 | CLIA (01) | IL |
31601157 | BLUE CROSS BLUE SHILED (01) | IL |
D16554 | (02) | IL |
P00448369 | RAILROAD MEDICARE (01) | IL |