Provider Demographics
NPI:1003082322
Name:UNIVERSAL MEDICAL GROUP LTD.
Entity Type:Organization
Organization Name:UNIVERSAL MEDICAL GROUP LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-283-6855
Mailing Address - Street 1:510 W TAFT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2029
Mailing Address - Country:US
Mailing Address - Phone:708-210-9085
Mailing Address - Fax:708-210-9386
Practice Address - Street 1:809 E 42ND PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-2903
Practice Address - Country:US
Practice Address - Phone:773-285-3422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060658Medicaid
IL036060658Medicaid
IL713830Medicare PIN