MEDICARE: DR. DOLLY THOMAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	036062674	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255359857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOLLY THOMAS MD

Provider Business Mailing Address
First Line	:	4014 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1832
Country	:	US
Telephone Number	:	773-283-9594
Fax Number	:	773-283-6711

Provider Business Practice Location Address
First Line	:	4014 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1832
Country	:	US
Telephone Number	:	773-283-9594
Fax Number	:	773-283-6711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	06/10/2010

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Directions to “ DR. DOLLY THOMAS MD” Practice Location

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