Healthcare Provider Details

I. General information

NPI: 1083241228
Provider Name (Legal Business Name): IAN STEPHON THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 COLUMBIA AVE E
BATTLE CREEK MI
49014-5159
US

IV. Provider business mailing address

1250 COLUMBIA AVE E STE A
BATTLE CREEK MI
49014-5167
US

V. Phone/Fax

Practice location:
  • Phone: 269-883-6052
  • Fax:
Mailing address:
  • Phone: 269-883-6052
  • Fax: 877-796-1484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number4301505818
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: