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General NPI Number Information
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NPI Number | 1083606677
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Entity Type | Organization
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Legal Business Name | T.K THOMAS MD PC
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 22480 KELLY RD SUITE 2
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City | EASTPOINTE
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State | MI
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Zip | 48021-2623
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Country | US
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Telephone | 586-776-3340
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Fax | 586-778-6460
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Provider Business Mailing Address
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Address Line | 842 MOORLAND DR
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City | GROSSE POINTE WOODS
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State | MI
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Zip | 48236-1129
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Country | US
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Telephone | 586-776-3340
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Fax | 586-778-6460
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. THOMAS K THOMAS
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Credential | MD
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Telephone | 586-776-3340
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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 | 4301040256
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License Number State | MI
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