Provider Demographics
NPI:1316135478
Name:CHILIS, THOMAS JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:CHILIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 RIVERSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3804
Mailing Address - Country:US
Mailing Address - Phone:847-821-9311
Mailing Address - Fax:
Practice Address - Street 1:135 RIVERSHIRE LN
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3804
Practice Address - Country:US
Practice Address - Phone:847-821-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45098Medicaid
IL352702/L36228Medicare PIN