Provider Demographics
NPI:1700987088
Name:THOMAS, KINGSLEY ARCHER (MD)
Entity Type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:ARCHER
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:989 UNIVERSITY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-1885
Mailing Address - Country:US
Mailing Address - Phone:248-373-2720
Mailing Address - Fax:248-373-3080
Practice Address - Street 1:989 UNIVERSITY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-1885
Practice Address - Country:US
Practice Address - Phone:248-373-2720
Practice Address - Fax:248-373-3080
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301033138208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA79368Medicare UPIN