MEDICARE: JAMES THOMPSON 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	207P00000X	Emergency Medicine Physician	036061098	IL

General Provider Information

NPI Number	:	1770963415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES THOMPSON MD

Provider Business Mailing Address
First Line	:	1508 TRIPLE CROWN CT
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-5815
Country	:	US
Telephone Number	:	630-414-2032
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 TRIPLE CROWN CT
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-5815
Country	:	US
Telephone Number	:	630-991-0083
Fax Number	:

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

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	06/08/2015

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