Healthcare Provider Details

I. General information

NPI: 1033177183
Provider Name (Legal Business Name): MARGARET M THOMSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 N. MAIN STREET
DECATUR IL
62526-4274
US

IV. Provider business mailing address

2905 N. MAIN STREET
DECATUR IL
62526-4274
US

V. Phone/Fax

Practice location:
  • Phone: 217-877-9117
  • Fax: 217-877-3077
Mailing address:
  • Phone: 217-877-9117
  • Fax: 217-877-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036061782
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.061782
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: