Healthcare Provider Details

I. General information

NPI: 1083662894
Provider Name (Legal Business Name): ISAAC THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S GREENLEAF ST STE 109
GURNEE IL
60031-5705
US

IV. Provider business mailing address

3915 OGLESBY AVE
GURNEE IL
60031-3358
US

V. Phone/Fax

Practice location:
  • Phone: 847-336-1600
  • Fax: 847-336-2380
Mailing address:
  • Phone: 847-336-1600
  • Fax: 847-336-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.063274
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13522
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036063274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: