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General NPI Number Information
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NPI Number | 1356346027
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Entity Type | Individual
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Provider Name | ROLAND LINCOLN THOMAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 85 E US HIGHWAY 6 STE 240
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City | VALPARAISO
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State | IN
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Zip | 46383
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Country | US
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Telephone | 219-983-6240
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Fax | 219-983-6040
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Provider Business Mailing Address
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Address Line | 2022 KELLE DR
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City | CHESTERTON
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State | IN
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Zip | 46304-8708
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Country | US
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Telephone | 219-364-3616
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Fax | 219-364-3910
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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 | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 01042586A
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License Number State | IN
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