Individual
DR. GUNILLA SIGRID CARLSSON THORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2900 FOXFIELD RD, ST CHARLES, IL 60174-5799
(630) 315-6500
(630) 615-6519
Mailing address
2900 FOXFIELD RD, ST CHARLES, IL 60174-5799
(630) 315-6500
(630) 615-6519
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
AN52403945287
IL
207R00000X
Internal Medicine Physician
AN52403945287
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036132093
—
IL
01
—
206147
MEDICARE (GROUP)
IL
01
—
CA4748
MEDICARE RR (GROUP)
IL
01
—
F400094850
MEDICARE (INDIVIDUAL)
IL
01
—
P01324606
MEDICARE RR (INDIVIDUAL)
IL
Enumeration date
08/14/2008
Last updated
08/11/2014
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