Healthcare Provider Details

I. General information

NPI: 1114920311
Provider Name (Legal Business Name): GREGORY ALLEN THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W MONROE ST SUITE 600
CHICAGO IL
60603-5300
US

IV. Provider business mailing address

33 W MONROE ST SUITE 600
CHICAGO IL
60603-5300
US

V. Phone/Fax

Practice location:
  • Phone: 312-894-5784
  • Fax:
Mailing address:
  • Phone: 312-894-5784
  • Fax: 312-894-5784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036-086468
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: