Provider Demographics
NPI:1689654725
Name:THOMAS, MIRIAM R (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 ELLIOTT DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8632
Mailing Address - Country:US
Mailing Address - Phone:734-822-2826
Mailing Address - Fax:734-434-9517
Practice Address - Street 1:5300 ELLIOTT DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8632
Practice Address - Country:US
Practice Address - Phone:734-434-6262
Practice Address - Fax:734-712-2820
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069323207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0812048OtherBCBS INDIVIDUAL
MI0H14989OtherBCBS GROUP
MI028223OtherMIDWEST HEALTH PLAN
MI5560329OtherCIGNA
MI7318554OtherAETNA
MIP00124944OtherMEDICARE RAILROAD PTAN
MI4620873Medicaid
MI0M86720011Medicare PIN
MI0M86730011Medicare PIN
MIH85832Medicare UPIN