Provider Demographics
NPI:1093808370
Name:THOMAS, LENO MAMMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LENO
Middle Name:MAMMEN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 S DOBSON RD STE 506
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4778
Mailing Address - Country:US
Mailing Address - Phone:480-412-6430
Mailing Address - Fax:
Practice Address - Street 1:1432 S DOBSON RD STE 506
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4778
Practice Address - Country:US
Practice Address - Phone:480-412-6430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116909208000000X
AZ432482080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ532608Medicaid
AZZ138615Medicare PIN