Healthcare Provider Details

I. General information

NPI: 1083606677
Provider Name (Legal Business Name): T.K THOMAS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22480 KELLY RD SUITE 2
EASTPOINTE MI
48021-2623
US

IV. Provider business mailing address

842 MOORLAND DR
GROSSE POINTE WOODS MI
48236-1129
US

V. Phone/Fax

Practice location:
  • Phone: 586-776-3340
  • Fax: 586-778-6460
Mailing address:
  • Phone: 586-776-3340
  • Fax: 586-778-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301040256
License Number StateMI

VIII. Authorized Official

Name: DR. THOMAS K THOMAS
Title or Position: PHYSICIAN
Credential: MD
Phone: 586-776-3340