Provider Demographics
NPI:1508893884
Name:THORS, GUNNAR (MD)
Entity Type:Individual
Prefix:
First Name:GUNNAR
Middle Name:
Last Name:THORS
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 1:1474 MERCHANT DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5917
Mailing Address - Country:US
Mailing Address - Phone:847-458-8808
Mailing Address - Fax:847-458-8822
Practice Address - Street 1:1474 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5917
Practice Address - Country:US
Practice Address - Phone:847-458-8808
Practice Address - Fax:847-458-8822
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0810762086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
132503800OtherUS DEPT OF LABOR-OWCP
IL240006456OtherRR MEDICARE
IL04923242OtherBLUECROSS/BLUESHIELD
IL240006455OtherRR MEDICARE
IL213893Medicare PIN
IL213891Medicare PIN
IL240006455OtherRR MEDICARE
IL240006456OtherRR MEDICARE
K29349Medicare ID - Type Unspecified
K21389Medicare ID - Type Unspecified
IL213892Medicare PIN