Provider Demographics
NPI:1619939212
Name:THOMAS, VICTOR L (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:408 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4091
Mailing Address - Country:US
Mailing Address - Phone:708-445-0898
Mailing Address - Fax:708-445-0907
Practice Address - Street 1:9718 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1007
Practice Address - Country:US
Practice Address - Phone:773-233-4100
Practice Address - Fax:773-233-4055
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036078052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078052Medicaid
IL036078052Medicaid