Provider Demographics
NPI:1598741050
Name:JAMES, THEODORE G (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:G
Last Name:JAMES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10660 W 143RD ST
Mailing Address - Street 2:STE B
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1982
Mailing Address - Country:US
Mailing Address - Phone:708-460-4499
Mailing Address - Fax:708-460-8031
Practice Address - Street 1:2310 YORK ST
Practice Address - Street 2:STE 2C
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2411
Practice Address - Country:US
Practice Address - Phone:708-388-4903
Practice Address - Fax:708-388-0043
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2015-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036039906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080178217OtherRR MEDICARE
IL1626986OtherBLUE SHIELD
IL036039906Medicaid
IL1626986OtherBLUE SHIELD
080178217OtherRR MEDICARE