Provider Demographics
NPI:1518162858
Name:THORNTON, RICK (DPM)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:THORNTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:RICKY
Other - Middle Name:
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1060 GRANDVIEW BLVD
Mailing Address - Street 2:SUITE 623
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35824-1497
Mailing Address - Country:US
Mailing Address - Phone:312-752-7713
Mailing Address - Fax:
Practice Address - Street 1:1060 GRANDVIEW BLVD
Practice Address - Street 2:SUITE 623
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35824-1497
Practice Address - Country:US
Practice Address - Phone:312-752-7713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005314213E00000X
TN689213E00000X
AL299213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-49599OtherBCBSAL
AL112600Medicaid
IL06-1763397OtherTAX ID #
IL01636612OtherBCBS PROVIDER #
IL214435Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
AL112600Medicaid