Provider Demographics
NPI:1124171459
Name:THOMAS, ASHA (MD)
Entity type:Individual
Prefix:DR
First Name:ASHA
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 1:2205 ENTERPRISE DR STE 520
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5820
Mailing Address - Country:US
Mailing Address - Phone:708-938-5783
Mailing Address - Fax:708-938-5941
Practice Address - Street 1:2205 ENTERPRISE DR STE 520
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5820
Practice Address - Country:US
Practice Address - Phone:708-938-5783
Practice Address - Fax:708-938-5941
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-089204207R00000X
IL036089204208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214881OtherMEDICARE GROUP PTAN
ILG14888Medicare UPIN