Individual
DR. DAISY CHACKO THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1669 BELVIDERE RD, BELVIDERE, IL 61008-9306
(815) 971-3030
(815) 971-9895
Mailing address
1669 BELVIDERE RD, BELVIDERE, IL 61008-9306
(815) 971-3030
(815) 971-9895
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036111218
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111218
—
IL
Enumeration date
07/07/2005
Last updated
01/16/2015
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