Provider Demographics
NPI:1437372828
Name:SIMS, THOMAS LESLIE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LESLIE
Last Name:SIMS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:840 S WOOD ST STE 416
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-413-7707
Mailing Address - Fax:312-355-1497
Practice Address - Street 1:840 S WOOD ST STE 416
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-413-7707
Practice Address - Fax:312-355-1497
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1210302086S0120X
390200000X
IL036146102208600000X, 2086S0102X, 2086S0120X
ORPG1634282086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036146102Medicaid