MEDICARE: MADHAVI THOMAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	L2694	TX

General Provider Information

NPI Number	:	1558337238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADHAVI THOMAS M.D.

Provider Business Mailing Address
First Line	:	4931 LONG PRAIRIE RD STE 100
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-2787
Country	:	US
Telephone Number	:	817-886-0369
Fax Number	:	817-268-9011

Provider Business Practice Location Address
First Line	:	4931 LONG PRAIRIE RD STE 100
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-2787
Country	:	US
Telephone Number	:	817-886-0369
Fax Number	:	817-268-9011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	05/30/2024

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