Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | 4301076069 | MI |
N | 208000000X | Pediatrician | 4301076069 | MI |
NPI | 1750304796 |
---|---|
Provider Name | Dr. Mark William Thomas |
First Address | Beverly Hills, MI 48025-5212 |
Second Address | Clarkston, MI 48346-1575 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H97939 | (02) | MI |