Provider Demographics
NPI:1659572014
Name:THOMAS, TARITA O (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:TARITA
Middle Name:O
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E HURON ST STE LC-178
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2908
Mailing Address - Country:US
Mailing Address - Phone:312-926-2520
Mailing Address - Fax:312-926-6374
Practice Address - Street 1:251 E HURON ST STE LC-178
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-2520
Practice Address - Fax:312-926-6374
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361256712085R0001X
MI43015032662085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology