Provider Demographics
NPI:1356814503
Name:THOMPSON MEDICAL INCORPORATED
Entity Type:Organization
Organization Name:THOMPSON MEDICAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMPSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIDZA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:773-271-9700
Mailing Address - Street 1:4564 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5602
Mailing Address - Country:US
Mailing Address - Phone:773-271-9700
Mailing Address - Fax:773-271-9700
Practice Address - Street 1:4564 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5602
Practice Address - Country:US
Practice Address - Phone:773-271-9700
Practice Address - Fax:773-271-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care