Basic Information
| Provider Information | |||||||||
| NPI: | 1124317367 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOTT | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 S MCHENRY RD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600896705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476180326 | ||||||||
| FaxNumber: | 8476180762 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 S MCHENRY RD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600896705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476180326 | ||||||||
| FaxNumber: | 8476180762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2011 | ||||||||
| LastUpdateDate: | 10/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 48929 | AZ | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RE0101X | 036140010 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207R00000X | 48929 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 974471 | 05 | AZ | MEDICAID | 036140010 | 05 | IL | MEDICAID |