1457359945 NPI number — DR. JEAN E THOMAS M.D.

Table of content: DR. JEAN E THOMAS M.D. (NPI 1457359945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457359945 NPI number — DR. JEAN E THOMAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
JEAN
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1457359945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1314 N MACOMB ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48162-3131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-242-6872
Provider Business Mailing Address Fax Number:
734-242-4962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1314 N MACOMB ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48162-3131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-242-6872
Provider Business Practice Location Address Fax Number:
734-242-4962
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZD0900X , with the licence number:  35074047 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 35074047 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2417683 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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