Provider Demographics
NPI:1821160888
Name:THOMAS, MARY JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8334 FORESTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-8895
Mailing Address - Country:US
Mailing Address - Phone:815-806-1432
Mailing Address - Fax:
Practice Address - Street 1:100 E JEFFERY ST
Practice Address - Street 2:SHAPIRO CENTER
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-5018
Practice Address - Country:US
Practice Address - Phone:815-939-8720
Practice Address - Fax:815-939-8383
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH58545Medicare UPIN
ILL91190Medicare ID - Type Unspecified