Provider Demographics
NPI:1689775991
Name:KINGSLEY THOMAS, M.D., P.C.
Entity Type:Organization
Organization Name:KINGSLEY THOMAS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-373-2720
Mailing Address - Street 1:989 UNIVERSITY DR
Mailing Address - Street 2:SUITE105
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-1885
Mailing Address - Country:US
Mailing Address - Phone:248-373-2720
Mailing Address - Fax:248-373-2720
Practice Address - Street 1:989 UNIVERSITY DR
Practice Address - Street 2:SUITE105
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-1885
Practice Address - Country:US
Practice Address - Phone:248-373-2720
Practice Address - Fax:248-373-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033138208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA79368Medicare UPIN