Provider Demographics
NPI:1942208772
Name:THOMAS, DAVID WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
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 1:5701 BOW POINTE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3198
Mailing Address - Country:US
Mailing Address - Phone:248-625-2621
Mailing Address - Fax:248-625-8938
Practice Address - Street 1:5701 BOW POINTE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3198
Practice Address - Country:US
Practice Address - Phone:248-625-2621
Practice Address - Fax:248-625-8938
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDT011134207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1942208772Medicaid
MIP00943457OtherRAILROAD MEDICARE IND PIN
MI0153628865OtherBCBS IND
MI0153628865OtherBCN IND
MI0153628865OtherBCN IND
MI1942208772Medicaid
MIMI2309050Medicare PIN
MI0153628865OtherBCBS IND