Basic Information
| Provider Information | |||||||||
| NPI: | 1114915063 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMETZ | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27702 NETWORK PLACE PRIMARY HEALTHCARE ASSOCIATES SC | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606731277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088627674 | ||||||||
| FaxNumber: | 7088621781 | ||||||||
| Practice Location | |||||||||
| Address1: | 19550 GOVERNORS HWY SUITE 1400 | ||||||||
| Address2: | PRIMARY HEALTHCARE ASSOCIATES, SC | ||||||||
| City: | FLOSSMOOR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604222136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086477565 | ||||||||
| FaxNumber: | 7082257671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 01/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 036072879 | IL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 036072879 | 05 | IL | MEDICAID | 31604221 | 01 | IL | BCBS | OTHER |