MEDICARE: THOMPSON MEDICAL INCORPORATED

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1356814503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMPSON MEDICAL INCORPORATED

Provider Business Mailing Address
First Line	:	4564 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5602
Country	:	US
Telephone Number	:	773-271-9700
Fax Number	:	773-271-9700

Provider Business Practice Location Address
First Line	:	4564 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5602
Country	:	US
Telephone Number	:	773-271-9700
Fax Number	:	773-271-9700

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	THOMPSON DZIDZA
Credential	:	PA
Telephone Number	:	773-271-9700

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	01/10/2021

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Directions to “THOMPSON MEDICAL INCORPORATED ” Practice Location

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