MEDICARE: DR. THEODORE G JAMES 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	207Q00000X	Family Medicine Physician	036039906	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080178217	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1626986	OTHER	IL	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598741050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE G JAMES MD

Provider Business Mailing Address
First Line	:	10660 W 143RD ST
Second Line	:	STE B
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-1982
Country	:	US
Telephone Number	:	708-460-4499
Fax Number	:	708-460-8031

Provider Business Practice Location Address
First Line	:	2310 YORK ST
Second Line	:	STE 2C
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-2411
Country	:	US
Telephone Number	:	708-388-4903
Fax Number	:	708-388-0043

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	04/21/2015

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