Healthcare Provider Details

I. General information

NPI: 1205078839
Provider Name (Legal Business Name): IMANI HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 03/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W ARTHINGTON ST 100
CHICAGO IL
60624-4280
US

IV. Provider business mailing address

3333 W ARTHINGTON ST 100
CHICAGO IL
60624-4280
US

V. Phone/Fax

Practice location:
  • Phone: 773-265-8540
  • Fax: 773-265-8541
Mailing address:
  • Phone: 773-265-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036098836
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036098836
License Number StateIL

VIII. Authorized Official

Name: DR. CYNTHIS CAY THOMAS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 773-265-8540