Provider Demographics
NPI:1265814396
Name:THOMAS, MEAGAN COURTNEY (DO)
Entity Type:Individual
Prefix:DR
First Name:MEAGAN
Middle Name:COURTNEY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MEAGAN
Other - Middle Name:COURTNEY
Other - Last Name:SHADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:38335 SAINT JOE DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-3851
Mailing Address - Country:US
Mailing Address - Phone:904-476-6804
Mailing Address - Fax:
Practice Address - Street 1:6245 INKSTER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135
Practice Address - Country:US
Practice Address - Phone:734-458-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021835207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine