Provider Demographics
NPI:1417972738
Name:THOMAS, NANCY THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:THOMAS
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:THOMAS
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:636 RAYMOND DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9791
Mailing Address - Country:US
Mailing Address - Phone:630-717-2300
Mailing Address - Fax:630-717-9638
Practice Address - Street 1:636 RAYMOND DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9791
Practice Address - Country:US
Practice Address - Phone:630-717-2300
Practice Address - Fax:630-717-9638
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115526Medicaid
IL2215474OtherBCBS OF ILLINOIS
IL2215474OtherBCBS OF ILLINOIS