Provider Demographics
NPI:1922464627
Name:THOMAS, ALEXANDER PAUL (DPM)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:PAUL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7243 CHASE RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1301
Mailing Address - Country:US
Mailing Address - Phone:313-582-6222
Mailing Address - Fax:313-582-0166
Practice Address - Street 1:7243 CHASE RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1301
Practice Address - Country:US
Practice Address - Phone:313-582-6222
Practice Address - Fax:313-582-0166
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002550213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922464627Medicaid
MIMI10749001Medicare PIN