Healthcare Provider Details

I. General information

NPI: 1750304796
Provider Name (Legal Business Name): MARK WILLIAM THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 N MAIN ST STE 205
CLARKSTON MI
48346-1575
US

IV. Provider business mailing address

19186 CHELTON DR
BEVERLY HILLS MI
48025-5212
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-9755
  • Fax: 248-620-9334
Mailing address:
  • Phone: 248-625-9755
  • Fax: 248-620-9334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number4301076069
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301076069
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: