Provider Demographics
NPI:1811976665
Name:THOMPSON, DANA MARA (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MARA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 E CHICAGO AVE # 25
Mailing Address - Street 2:ANN AND ROBERT H LURIE CHILDREN'S HOSPITAL OF CHICAGO
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-4000
Mailing Address - Fax:312-225-9414
Practice Address - Street 1:225 E CHICAGO AVE # 25
Practice Address - Street 2:ANN AND ROBERT H LURIE CHILDREN'S HOSPITAL OF CHICAGO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-4000
Practice Address - Fax:312-225-9414
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.072848207YP0228X
MN35521207YP0228X
IL036.131871207YP0228X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN389020100Medicaid
MN040013679OtherMEDICARE RAILROAD
MN040013679OtherMEDICARE RAILROAD
F45267Medicare UPIN