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General NPI Number Information
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NPI Number | 1467431551
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Entity Type | Individual
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Provider Name | CHINNAMMA THOMAS MD
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Gender | Female
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 03/05/2010
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Provider Practice Location Address
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Address Line | 2160 S FIRST AVE (EMS BLDG., RM. 2209)
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City | MAYWOOD
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State | IL
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Zip | 60153
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Country | US
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Telephone | 708-327-3250
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Fax | 708-327-2620
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Provider Business Mailing Address
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Address Line | 2160 S FIRST AVE (EMS BLDG., RM. 2209)
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City | MAYWOOD
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State | IL
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Zip | 60153
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Country | US
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Telephone | 708-327-3250
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Fax | 708-327-2620
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZN0500X
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Taxonomy Name | Neuropathology Physician
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License Number | 36048135
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License Number State | IL
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