MEDICARE: BIMEL THOMAS MD

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	207R00000X	Internal Medicine Physician	036157799	IL
2	208M00000X	Hospitalist Physician	036157799	IL

General Provider Information

NPI Number	:	1689169690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIMEL THOMAS MD

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	479-826-7158
Fax Number	:

Provider Business Practice Location Address
First Line	:	5145 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3687
Country	:	US
Telephone Number	:	773-878-8200
Fax Number	:	773-989-1734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	06/02/2022

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