1508893884 NPI number — GUNNAR THORS M.D.

Table of content: GUNNAR THORS M.D. (NPI 1508893884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508893884 NPI number — GUNNAR THORS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORS
Provider First Name:
GUNNAR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1508893884
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1474 MERCHANT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALGONQUIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60102-5917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-458-8808
Provider Business Mailing Address Fax Number:
847-458-8822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1474 MERCHANT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALGONQUIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60102-5917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-458-8808
Provider Business Practice Location Address Fax Number:
847-458-8822
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  036-081076 , 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)

  • Identifier: 132503800 . This is a "US DEPT OF LABOR-OWCP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 240006456 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 04923242 . This is a "BLUECROSS/BLUESHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 240006455 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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