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General NPI Number Information
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NPI Number | 1821160888
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Entity Type | Individual
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Provider Name | MARY JANE THOMAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 100 E JEFFERY ST SHAPIRO CENTER
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City | KANKAKEE
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State | IL
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Zip | 60901-5018
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Country | US
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Telephone | 815-939-8720
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Fax | 815-939-8383
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Provider Business Mailing Address
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Address Line | 8334 FORESTVIEW CT
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City | FRANKFORT
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State | IL
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Zip | 60423-8895
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Country | US
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Telephone | 815-806-1432
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Fax |
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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 |
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License Number State | IL
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