Provider Demographics
NPI:1255359857
Name:THOMAS, DOLLY (MD)
Entity type:Individual
Prefix:DR
First Name:DOLLY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1832
Mailing Address - Country:US
Mailing Address - Phone:773-283-9594
Mailing Address - Fax:773-283-6711
Practice Address - Street 1:4014 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1832
Practice Address - Country:US
Practice Address - Phone:773-283-9594
Practice Address - Fax:773-283-6711
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062674207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062674Medicaid
IL730260Medicare ID - Type Unspecified
IL036062674Medicaid