MEDICARE: BONNIE WILLIAM THOMAS JR. 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	207R00000X	Internal Medicine Physician	036101029	IL
2	207R00000X	Internal Medicine Physician	036102029	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	:	1851321467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE WILLIAM THOMAS JR. MD

Provider Business Mailing Address
First Line	:	1525 E 55TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5512
Country	:	US
Telephone Number	:	773-548-3957
Fax Number	:	773-753-5590

Provider Business Practice Location Address
First Line	:	1525 E 55TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5512
Country	:	US
Telephone Number	:	773-548-3957
Fax Number	:	773-753-5590

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	01/06/2022

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