Basic Information
Provider Information
NPI: 1255356689
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THOMAS
FirstName: ABRAHAM
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 120 W 22ND ST STE 200
Address2:  
City: OAK BROOK
State: IL
PostalCode: 605231563
CountryCode: US
TelephoneNumber: 6305735000
FaxNumber: 7084227816
Practice Location
Address1: 9125 S PULASKI RD
Address2:  
City: EVERGREEN PARK
State: IL
PostalCode: 608051441
CountryCode: US
TelephoneNumber: 7084227715
FaxNumber: 7084227816
Other Information
ProviderEnumerationDate: 07/13/2006
LastUpdateDate: 05/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X036110529ILN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RN0300X036110529ILY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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