Healthcare Provider Details

I. General information

NPI: 1306994090
Provider Name (Legal Business Name): MICHELLE THOMAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE CAFFEY NP

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 SUMMIT DR
WATERFORD MI
48328-3364
US

IV. Provider business mailing address

PO BOX 430150
PONTIAC MI
48343-0150
US

V. Phone/Fax

Practice location:
  • Phone: 248-724-7700
  • Fax: 248-636-4025
Mailing address:
  • Phone: 248-724-7700
  • Fax: 248-636-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704130444
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: