Provider Demographics
NPI:1043763279
Name:THOMAS, SHELBY II
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:THOMAS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3077
Mailing Address - Country:US
Mailing Address - Phone:313-671-7109
Mailing Address - Fax:
Practice Address - Street 1:16300 FAIRFAX ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3077
Practice Address - Country:US
Practice Address - Phone:313-671-7109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-23
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other