Healthcare Provider Details

I. General information

NPI: 1760797260
Provider Name (Legal Business Name): ALVIN THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 CHURCH STREET
ANN ARBOR MI
48109-1043
US

IV. Provider business mailing address

3109 WOODLAND HILLS DRIVE APT 22
ANN ARBOR MI
48108-1043
US

V. Phone/Fax

Practice location:
  • Phone: 734-615-7853
  • Fax:
Mailing address:
  • Phone: 404-642-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: