MEDICARE: MISS NITHA MARY THOMAS PA

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	363A00000X	Physician Assistant	5601008874	MI

General Provider Information

NPI Number	:	1841766599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NITHA MARY THOMAS PA

Provider Business Mailing Address
First Line	:	650 E BIG BEAVER RD STE C
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-1432
Country	:	US
Telephone Number	:	248-781-8921
Fax Number	:	248-781-8923

Provider Business Practice Location Address
First Line	:	650 E BIG BEAVER RD STE C
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-1432
Country	:	US
Telephone Number	:	248-781-8921
Fax Number	:	248-781-8923

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

Provider Enumeration Date	:	10/21/2018
Last Update Date	:	05/05/2026

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