Provider Demographics
NPI:1306819461
Name:THOMAS, STEVEN V (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:V
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 1:4110 COPPER RIDGE DR
Mailing Address - Street 2:STE 242 BLDG D
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:231-929-7700
Mailing Address - Fax:231-929-7709
Practice Address - Street 1:4110 COPPER RIDGE DR
Practice Address - Street 2:STE 242 BLDG D
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-929-7700
Practice Address - Fax:231-929-7709
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054838208200000X
MIST054838208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104859055Medicaid
MI2402810801OtherBLUE CROSS BLUE SHIELD
MI2402810801OtherBLUE CARE NETWORK
MI2402810801OtherBLUE CARE NETWORK
MIP30000001Medicare PIN