MEDICARE: KEJUANNA THOMAS

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1891474094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEJUANNA THOMAS

Provider Business Mailing Address
First Line	:	7436 OAKLAND ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-1352
Country	:	US
Telephone Number	:	734-259-6644
Fax Number	:

Provider Business Practice Location Address
First Line	:	7436 OAKLAND ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-1352
Country	:	US
Telephone Number	:	734-259-6644
Fax Number	:

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

Provider Enumeration Date	:	07/14/2023
Last Update Date	:	07/14/2023

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Directions to “ KEJUANNA THOMAS ” Practice Location

Language	Start Address	Practice Location

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