Individual
KATHLEEN M BEWLEY-THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
16650 HARLEM AVE STE 1, TINLEY PARK, IL 60477-1847
(708) 444-1512
(708) 444-1878
Mailing address
35318 EAGLE WAY, CHICAGO, IL 60678-1353
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036108151
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036108151
—
IL
01
—
F400310890
MEDICARE PTAN
—
01
—
IL5686
FPN GROUP MEDICARE PTAN
—
Enumeration date
06/21/2005
Last updated
05/19/2022
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