Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 4301055015 | MI |
NPI | 1083707111 |
---|---|
Provider Name | Shanti Thomas |
First Address | Southfield, MI 48033-3849 |
Second Address | Brownstown Twp, MI 48183-1090 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4695453 | (05) | MI |
F64857 | (02) | |
P00139598 | US RAILROAD RETIREMENT (01) | MI |