MEDICARE: DR. MARK ALBERT THOMPSON M.D.

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	2000753	LA
2	207RC0000X	Cardiovascular Disease Physician	MD.200753	LA
3	207RC0000X	Cardiovascular Disease Physician	P2545	TX
4	207RC0000X	Cardiovascular Disease Physician	036.151584	IL
5	207R00000X	Internal Medicine Physician	125050537	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8DK391	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750588661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALBERT THOMPSON M.D.

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:	847-390-4757

Provider Business Practice Location Address
First Line	:	2301 E 93RD ST STE 115
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3986
Country	:	US
Telephone Number	:	708-799-8700
Fax Number	:	708-957-1830

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

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	10/06/2022

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Directions to “ DR. MARK ALBERT THOMPSON M.D.” Practice Location

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