Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | POD.0000460 | CO |
N | 213ES0103X | Foot & Ankle Surgery | POD.0000460 | CO |
NPI | 1164458006 |
---|---|
Provider Name | Dr. Michael I Thomas |
First Address | Fort Collins, CO 80526-5283 |
Second Address | Fort Collins, CO 80524-4366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 10/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01004605 | (05) | CO |
113903700 | (05) | WY |