Provider Demographics
NPI:1477504579
Name:THOMAS, JOSEPH S (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9727 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1723
Mailing Address - Country:US
Mailing Address - Phone:773-881-3400
Mailing Address - Fax:773-881-0777
Practice Address - Street 1:9727 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1723
Practice Address - Country:US
Practice Address - Phone:773-881-3400
Practice Address - Fax:773-881-0777
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068845207VF0040X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068845Medicaid
IL14D881319OtherCLIA
ILP00448369OtherRAILROAD MEDICARE
IL31601157OtherBLUE CROSS BLUE SHILED
ILD16554Medicare UPIN
IL778530Medicare PIN