Provider Demographics
NPI:1376732073
Name:THOMAS, THOMAS K (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1361698Medicaid
MI71020001500026OtherBC BS OF MICHIGAN
MI1361698Medicaid
MIP52560001Medicare PIN