Provider Demographics
NPI:1235141359
Name:THOMAS, MICHAEL F (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W POLK ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3723
Mailing Address - Country:US
Mailing Address - Phone:312-864-4452
Mailing Address - Fax:312-864-9500
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-425-9399
Practice Address - Fax:708-425-9306
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062633207R00000X
IL036-062633207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062633Medicaid
ILC43674Medicare UPIN
IL036062633Medicaid