Individual
ANGELA MARY THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3860 W OGDEN AVE, CHICAGO, IL 60623
(872) 588-3000
Mailing address
2251 ASH ST, DES PLAINES, IL 60018
(224) 489-9398
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085.006841
IL
363A00000X
Physician Assistant
Primary
085006841
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085006841
STATE LICENSE
IL
01
—
1145736
SPECIALTY BOARDS
IL
01
—
385005355
CS LICENSE
IL
Enumeration date
11/28/2018
Last updated
03/07/2023
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