Provider Demographics
NPI:1073746046
Name:THOMAS, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:9760 S KEDZIE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3109
Mailing Address - Country:US
Mailing Address - Phone:708-423-8150
Mailing Address - Fax:708-423-8152
Practice Address - Street 1:9760 S KEDZIE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-3109
Practice Address - Country:US
Practice Address - Phone:708-423-8150
Practice Address - Fax:708-423-8152
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125-057241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205196005Medicare PIN