1285060475 NPI number — MDHEARINGAID

Table of content: DR. SHERRY MARIE THOMPSON M.D. (NPI 1235340324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285060475 NPI number — MDHEARINGAID

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MDHEARINGAID
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285060475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
917 W WASHINGTON BLVD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60607-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-670-4327
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
917 W WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60607-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-670-4327
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHERUKURI
Authorized Official First Name:
SREEKANT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
312-869-4327

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X , with the licence number:  66186741 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)