Basic Information
| Provider Information | |||||||||
| NPI: | 1083241228 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | STEPHON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 ARLINGTON AVE APT 8 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436091962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162049679 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7045 LIGHTHOUSE WAY | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435517000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198736836 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2020 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | 35.143499 | OH | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.