Provider Demographics
NPI:1083662894
Name:THOMAS, ISAAC (MD)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 OGLESBY AVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3358
Mailing Address - Country:US
Mailing Address - Phone:847-336-1600
Mailing Address - Fax:847-336-2380
Practice Address - Street 1:3915 OGLESBY AVE
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3358
Practice Address - Country:US
Practice Address - Phone:847-336-1600
Practice Address - Fax:847-336-2380
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063274174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063274Medicaid
IL763284OtherRAILROAD MEDICARE
IL763284OtherRAILROAD MEDICARE
IL036063274Medicaid