Healthcare Provider Details

I. General information

NPI: 1699733774
Provider Name (Legal Business Name): ROBERT D. THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 DIXIE HWY
CHICAGO HTS IL
60411-1748
US

IV. Provider business mailing address

333 DIXIE HWY
CHICAGO HTS IL
60411-1748
US

V. Phone/Fax

Practice location:
  • Phone: 708-756-0100
  • Fax: 708-709-6353
Mailing address:
  • Phone: 708-756-0100
  • Fax: 708-709-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036111289
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036.111289
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: