Individual
FAITH ROBERTHA THORNTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
31 W 155TH ST, HARVEY, IL 60426-3556
(708) 596-5177
(708) 596-5518
Mailing address
31 W 155TH ST, HARVEY, IL 60426-3556
(708) 596-5177
(708) 596-5518
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036163716
IL
390200000X
Student in an Organized Health Care Education/Training Program
5151014277
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036163716
—
IL
Enumeration date
04/13/2020
Last updated
08/28/2023
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