Healthcare Provider Details

I. General information

NPI: 1710969001
Provider Name (Legal Business Name): LYNELLE EVELEEN THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1786 MOON LAKE BLVD LOWER LEVEL
HOFFMAN ESTATES IL
60194-5029
US

IV. Provider business mailing address

1786 MOON LAKE BLVD LOWER LEVEL
HOFFMAN ESTATES IL
60194-5029
US

V. Phone/Fax

Practice location:
  • Phone: 847-755-8090
  • Fax: 847-843-7393
Mailing address:
  • Phone: 847-755-8090
  • Fax: 847-843-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number034489
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036-083202
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: