Provider Demographics
NPI:1083753214
Name:THOMPSON, HARRY REED JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:REED
Last Name:THOMPSON
Suffix:JR
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 1:413 E UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3826
Mailing Address - Country:US
Mailing Address - Phone:217-359-9601
Mailing Address - Fax:217-359-9609
Practice Address - Street 1:413 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3826
Practice Address - Country:US
Practice Address - Phone:217-359-9601
Practice Address - Fax:217-359-9609
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065943208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371189625OtherTAX ID MISC INSURANCES
IL020032301OtherRAILROAD MEDICARE
IL0001000344OtherBLUE SHIELD OF IL
IL036065943Medicaid
IL3567913001OtherCIGNA INSURANCE
IL371189625OtherTAX ID MISC INSURANCES
IL020032301OtherRAILROAD MEDICARE