Provider Demographics
NPI:1467693010
Name:MICHELLE THOMAS MD
Entity Type:Organization
Organization Name:MICHELLE THOMAS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:PAO
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-644-1033
Mailing Address - Street 1:3340 PROVIDENCE DR
Mailing Address - Street 2:STE 359
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4627
Mailing Address - Country:US
Mailing Address - Phone:907-644-1033
Mailing Address - Fax:907-644-0764
Practice Address - Street 1:3340 PROVIDENCE DR
Practice Address - Street 2:STE 359
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4627
Practice Address - Country:US
Practice Address - Phone:907-644-1033
Practice Address - Fax:907-644-0764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2563 AKMedicaid
AKMD2563 AKMedicaid
AKK164876Medicare Oscar/Certification
E67926AKMedicare UPIN