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General NPI Number Information
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NPI Number | 1356814503
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Entity Type | Organization
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Legal Business Name | THOMPSON MEDICAL INCORPORATED
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 01/10/2021
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Provider Practice Location Address
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Address Line | 4564 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60640-5602
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Country | US
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Telephone | 773-271-9700
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Fax | 773-271-9700
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Provider Business Mailing Address
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Address Line | 4564 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60640-5602
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Country | US
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Telephone | 773-271-9700
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Fax | 773-271-9700
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | THOMPSON DZIDZA
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Credential | PA
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Telephone | 773-271-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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