Provider Demographics
NPI:1114915063
Name:THOMETZ, JOSEPH G (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:G
Last Name:THOMETZ
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 1:27702 NETWORK PLACE PRIMARY HEALTHCARE ASSOCIATES SC
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1277
Mailing Address - Country:US
Mailing Address - Phone:708-862-7674
Mailing Address - Fax:708-862-1781
Practice Address - Street 1:19550 GOVERNORS HWY SUITE 1400
Practice Address - Street 2:PRIMARY HEALTHCARE ASSOCIATES, SC
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2136
Practice Address - Country:US
Practice Address - Phone:708-647-7565
Practice Address - Fax:708-225-7671
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072879207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072879Medicaid
IL31604221OtherBCBS
IL31604221OtherBCBS
976280Medicare ID - Type Unspecified