Provider Demographics
NPI:1477501294
Name:THOMAS, JAYA (MD)
Entity Type:Individual
Prefix:
First Name:JAYA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 OGLESBY AVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3358
Mailing Address - Country:US
Mailing Address - Phone:847-336-1600
Mailing Address - Fax:847-336-2380
Practice Address - Street 1:3915 OGLESBY AVE
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3358
Practice Address - Country:US
Practice Address - Phone:847-336-1600
Practice Address - Fax:847-336-2380
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070603174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070603Medicaid
ILE71103Medicare UPIN