Healthcare Provider Details

I. General information

NPI: 1033109251
Provider Name (Legal Business Name): SHIRLEY A THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13914 SOUTHEASTERN PKWY SUITE 314
FISHERS IN
46037-7127
US

IV. Provider business mailing address

2799 CIRCLE COURT
CARMEL IN
46032
US

V. Phone/Fax

Practice location:
  • Phone: 317-872-1415
  • Fax: 317-337-2571
Mailing address:
  • Phone: 317-871-2799
  • Fax: 317-337-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01030422A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: