Healthcare Provider Details

I. General information

NPI: 1477504579
Provider Name (Legal Business Name): JOSEPH S THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9727 S WESTERN AVE
CHICAGO IL
60643-1723
US

IV. Provider business mailing address

9727 S WESTERN AVE
CHICAGO IL
60643-1723
US

V. Phone/Fax

Practice location:
  • Phone: 773-881-3400
  • Fax: 773-881-0777
Mailing address:
  • Phone: 773-881-3400
  • Fax: 773-881-0777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number036068845
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036068845
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: