Provider Demographics
NPI:1235180902
Name:THOMMA, MARK STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:THOMMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:405 N WABASH AVE
Mailing Address - Street 2:APT. 4905
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3591
Mailing Address - Country:US
Mailing Address - Phone:312-828-9670
Mailing Address - Fax:312-828-9671
Practice Address - Street 1:405 N WABASH AVE
Practice Address - Street 2:APT. 4905
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3591
Practice Address - Country:US
Practice Address - Phone:312-828-9670
Practice Address - Fax:312-828-9671
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE 85270Medicare UPIN