Healthcare Provider Details

I. General information

NPI: 1649289083
Provider Name (Legal Business Name): FLORENCE THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 N TELEGRAPH RD
PONTIAC MI
48341-1037
US

IV. Provider business mailing address

30 W MONROE ST STE 1200
CHICAGO IL
60603-2420
US

V. Phone/Fax

Practice location:
  • Phone: 248-234-7540
  • Fax: 248-581-8716
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301074204
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: