Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301098814 | MI |
Y | 2080P0214X | Pediatric Pulmonologist | 4301098814 | MI |
NPI | 1245527159 |
---|---|
Provider Name | Ryan G Thomas |
First Address | East Lansing, MI 48824-7015 |
Second Address | East Lansing, MI 48823-6819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2011 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245527159 | (05) | MI |