MEDICARE: KISHA DENISE THOMAS MD

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	207L00000X	Anesthesiology Physician	01075431A	IN
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME137547	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000947766	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962728915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISHA DENISE THOMAS MD

Provider Business Mailing Address
First Line	:	1100 REID PKWY
Second Line	:	MEDICAL STAFF SERVICES
City	:	RICHMOND
State	:	IN
Zip	:	47374-1157
Country	:	US
Telephone Number	:	765-935-8902
Fax Number	:	765-983-3219

Provider Business Practice Location Address
First Line	:	7207 GOLDEN WINGS RD STE 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-3324
Country	:	US
Telephone Number	:	904-389-1010
Fax Number	:	904-389-1082

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	10/22/2018

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Directions to “ KISHA DENISE THOMAS MD” Practice Location

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