MEDICARE: DR. MICHAEL I THOMAS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	POD.0000460	CO
2	213EP1101X	Primary Podiatric Medicine Podiatrist	POD.0000460	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164458006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL I THOMAS DPM

Provider Business Mailing Address
First Line	:	2620 KIT FOX CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-5283
Country	:	US
Telephone Number	:	970-377-0113
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 RIVERSIDE AVE STE C
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4366
Country	:	US
Telephone Number	:	970-484-4620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	01/10/2017

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