Individual
DR. NIMMY THOMAS THAKOLKARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1725 W HARRISON ST STE 955, CHICAGO, IL 60612-3862
(312) 942-7030
(312) 563-4212
Mailing address
1725 W HARRISON ST STE 955, CHICAGO, IL 60612-3862
(312) 942-7030
(312) 563-4212
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125.064449
IL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
036.143418
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100191458
—
WI
Enumeration date
06/26/2014
Last updated
04/20/2022
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