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General NPI Number Information
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NPI Number | 1083241228
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Entity Type | Individual
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Provider Name | IAN STEPHON THOMAS MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 1250 COLUMBIA AVE E
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City | BATTLE CREEK
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State | MI
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Zip | 49014-5159
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Country | US
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Telephone | 269-883-6052
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Fax |
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Provider Business Mailing Address
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Address Line | 960 MASS AVE STE 2
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City | BOSTON
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State | MA
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Zip | 02118-2690
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1015023
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 4301505818
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 35.143499
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301505818
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License Number State | MI
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