Provider Demographics
NPI:1245361708
Name:THOMAS, ANTHONY V (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:V
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 N MITTEL BLVD
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1024
Mailing Address - Country:US
Mailing Address - Phone:630-595-3888
Mailing Address - Fax:630-595-6910
Practice Address - Street 1:1355 N MITTEL BLVD
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1024
Practice Address - Country:US
Practice Address - Phone:630-595-3888
Practice Address - Fax:630-595-6910
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36066153207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL85550Medicare ID - Type Unspecified
ILG83217Medicare UPIN