Healthcare Provider Details

I. General information

NPI: 1134964174
Provider Name (Legal Business Name): ANTHONY THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 8TH ST STE 3A158
SPRINGFIELD IL
62701-1085
US

IV. Provider business mailing address

301 N 8TH ST STE 3A158
SPRINGFIELD IL
62701-1085
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-3134
  • Fax:
Mailing address:
  • Phone: 217-545-3134
  • 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 Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125087751
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: