Provider Demographics
NPI:1023115342
Name:THOMAS, CHARLES E (PA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1200 EAST MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 655
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912
Mailing Address - Country:US
Mailing Address - Phone:517-267-2460
Mailing Address - Fax:
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 655
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-267-2460
Practice Address - Fax:517-267-2462
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301050648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R65600Medicare UPIN
MIC36179033Medicare PIN