Healthcare Provider Details

I. General information

NPI: 1104445857
Provider Name (Legal Business Name): FAITH ROBERTHA THORNTON-CHATMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FAITH ROBERTHA THORNTON DO

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10536 S EWING AVE
CHICAGO IL
60617-6219
US

IV. Provider business mailing address

10536 S EWING AVE
CHICAGO IL
60617-6219
US

V. Phone/Fax

Practice location:
  • Phone: 708-768-5000
  • Fax: 773-978-5329
Mailing address:
  • Phone: 708-768-5000
  • Fax: 773-978-5329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036163716
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: