Provider Demographics
NPI:1295750107
Name:KISHORE THAMPY, M.D.,S.C.
Entity type:Organization
Organization Name:KISHORE THAMPY, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:
Authorized Official - Last Name:THAMPY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-584-2324
Mailing Address - Street 1:PO BOX 388320
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-8320
Mailing Address - Country:US
Mailing Address - Phone:773-767-4600
Mailing Address - Fax:776-767-8320
Practice Address - Street 1:1955 US 1 S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3708
Practice Address - Country:US
Practice Address - Phone:563-599-9396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA45495OtherBLUE SHIELD
260025865OtherRAILROAD MEDICARE
IL021604125OtherBLUE SHIELD
IA1133389Medicaid
IL036048133Medicaid
P00134680OtherRAILROAD MEDICARE
IL021604125OtherBLUE SHIELD
IA45495Medicare ID - Type Unspecified
IL036048133Medicaid