Provider Demographics
NPI:1356848790
Name:THOMAN, SHILOH ROSE (DPM)
Entity type:Individual
Prefix:DR
First Name:SHILOH
Middle Name:ROSE
Last Name:THOMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 MEDICAL PLAZA DR STE 180
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3250
Mailing Address - Country:US
Mailing Address - Phone:541-740-0462
Mailing Address - Fax:
Practice Address - Street 1:1120 MEDICAL PLAZA DR STE 180
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3250
Practice Address - Country:US
Practice Address - Phone:281-364-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.004000213ES0103X
390200000X
TX692179213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program