Provider Demographics
NPI:1679184972
Name:THOMAS, RONALD KEITH
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:KEITH
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CONNER ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2407
Mailing Address - Country:US
Mailing Address - Phone:313-801-1853
Mailing Address - Fax:
Practice Address - Street 1:2900 CONNER ST BLDG A
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2407
Practice Address - Country:US
Practice Address - Phone:313-801-1853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist