Provider Demographics
NPI:1245338961
Name:THOMAS, DANIEL EA (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EA
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 1:12745 S SAGINAW ST
Mailing Address - Street 2:SUITE 806
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2437
Mailing Address - Country:US
Mailing Address - Phone:810-691-0971
Mailing Address - Fax:
Practice Address - Street 1:12745 S SAGINAW ST
Practice Address - Street 2:SUITE 806
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2437
Practice Address - Country:US
Practice Address - Phone:810-691-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001885213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4852511770OtherBCBS
MI4634390001Medicare NSC
MIU75955Medicare UPIN
MI0N61210001Medicare PIN