Provider Demographics
NPI:1467474031
Name:THOMAS, KATHLEEN M (DO)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9669 E 146TH ST
Practice Address - Street 2:SUITE 250A
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5004
Practice Address - Country:US
Practice Address - Phone:317-621-1340
Practice Address - Fax:317-621-1341
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02002532A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000658832OtherANTHEM
INP01009931OtherMEDICARE RR
IN000000575025OtherANTHEM
IN200469250Medicaid
IN000000575025OtherANTHEM
IN200469250Medicaid