Provider Demographics
NPI:1427018571
Name:THOMAS, PRESTON DUANE (MD)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:DUANE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5210 HIGHLAND RD
Mailing Address - Street 2:STE 201
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1970
Mailing Address - Country:US
Mailing Address - Phone:248-674-2259
Mailing Address - Fax:248-674-3356
Practice Address - Street 1:46 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2155
Practice Address - Country:US
Practice Address - Phone:248-322-6747
Practice Address - Fax:248-322-5787
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301076748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4632453Medicaid
MIN68690003Medicare ID - Type Unspecified
MIH85136Medicare UPIN