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General NPI Number Information
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NPI Number | 1619939212
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Entity Type | Individual
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Provider Name | VICTOR L THOMAS MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 9718 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60628-1007
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Country | US
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Telephone | 773-233-4100
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Fax | 773-233-4055
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Provider Business Mailing Address
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Address Line | 408 MADISON ST
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City | OAK PARK
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State | IL
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Zip | 60302-4091
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Country | US
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Telephone | 708-445-0898
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Fax | 708-445-0907
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036078052
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License Number State | IL
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