MEDICARE: THAMANI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	071009493	IL

General Provider Information

NPI Number	:	1437639473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THAMANI

Provider Business Mailing Address
First Line	:	2020 N CALIFORNIA AVE STE 7
Second Line	:	BOX 220
City	:	CHICAGO
State	:	IL
Zip	:	60647-6320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3036 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3539
Country	:	US
Telephone Number	:	773-270-2150
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT
Name	:	JONATHAN WILDT
Credential	:
Telephone Number	:	217-370-7540

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	08/20/2018

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