Healthcare Provider Details

I. General information

NPI: 1669433025
Provider Name (Legal Business Name): MICHAEL J THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 HWY 190 E SERV RD SUITE 200
COVINGTON LA
70433-4960
US

IV. Provider business mailing address

PO BOX 129
MADISONVILLE LA
70447-0129
US

V. Phone/Fax

Practice location:
  • Phone: 985-234-3000
  • Fax: 985-234-3002
Mailing address:
  • Phone: 985-234-3000
  • Fax: 985-234-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number022130
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: