1144365388 NPI number — ANDREW THOMAS, M.D.,P.C.

Table of content: (NPI 1144365388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144365388 NPI number — ANDREW THOMAS, M.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDREW THOMAS, M.D.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144365388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5576 WOODHALL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48224-2135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-833-5032
Provider Business Mailing Address Fax Number:
313-833-7851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4727 SAINT ANTOINE ST
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-1461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-833-5032
Provider Business Practice Location Address Fax Number:
313-833-7851
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
NMN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
313-680-0619

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301051568 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OP24430 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4742428 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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