Healthcare Provider Details

I. General information

NPI: 1386866689
Provider Name (Legal Business Name): MICHELLE A THOMAS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6061 N FIRST SUITE 102
FRESNO CA
93729
US

IV. Provider business mailing address

PO BOX 26414
FRESNO CA
93729-6414
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-6800
  • Fax: 559-432-6809
Mailing address:
  • Phone: 559-432-6800
  • Fax: 559-432-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA62122
License Number StateCA

VIII. Authorized Official

Name: DR. MICHELLE ANTIONETTE THOMAS
Title or Position: CEO
Credential: M.D.
Phone: 559-432-6800