Provider Demographics
NPI:1588673461
Name:THOMAS, MICHAEL A (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:#102
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5150
Mailing Address - Country:US
Mailing Address - Phone:954-458-4488
Mailing Address - Fax:954-458-2928
Practice Address - Street 1:3127 W HALLANDALE BEACH BLVD
Practice Address - Street 2:#102
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009-5150
Practice Address - Country:US
Practice Address - Phone:954-458-4488
Practice Address - Fax:954-458-2928
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12914207T00000X, 208VP0014X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8209967Medicaid
G8800134Medicare PIN
WA8209967Medicaid