Provider Demographics
NPI:1013913557
Name:BEWLEY-THOMAS, KATHLEEN M (DO)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:BEWLEY-THOMAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35318 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-1353
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:16650 HARLEM AVE STE 1
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1847
Practice Address - Country:US
Practice Address - Phone:708-444-1512
Practice Address - Fax:708-444-1878
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5686OtherFPN GROUP MEDICARE PTAN
F400310890OtherMEDICARE PTAN
IL036108151Medicaid
IL036108151Medicaid