Provider Demographics
NPI:1528397668
Name:THOMAS, ANJITHA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANJITHA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S GARY AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2218
Mailing Address - Country:US
Mailing Address - Phone:630-893-9661
Mailing Address - Fax:877-780-5145
Practice Address - Street 1:245 S GARY AVE STE 207
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2218
Practice Address - Country:US
Practice Address - Phone:630-893-9661
Practice Address - Fax:877-780-5145
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003425363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical