Healthcare Provider Details

I. General information

NPI: 1750028403
Provider Name (Legal Business Name): CHASE THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2022
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST STE 403
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

3201 SPRINGHILL DR STE 100
NORTH LITTLE ROCK AR
72117-2905
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5495
  • Fax:
Mailing address:
  • Phone: 501-955-4530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number125086683
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: