Provider Demographics
NPI:1083606677
Name:T.K THOMAS MD PC
Entity Type:Organization
Organization Name:T.K THOMAS MD PC
Other - Org Name:THOMAS K THOMAS MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-776-3340
Mailing Address - Street 1:842 MOORLAND DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1129
Mailing Address - Country:US
Mailing Address - Phone:586-776-3340
Mailing Address - Fax:586-778-6460
Practice Address - Street 1:22480 KELLY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2623
Practice Address - Country:US
Practice Address - Phone:586-776-3340
Practice Address - Fax:586-778-6460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI71020001500026OtherBC BS OF MICHIGAN
MI1361698Medicaid
MI71020001500026OtherBC BS OF MICHIGAN
MI0P52560Medicare PIN