Basic Information
Provider Information
NPI: 1649289083
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THOMAS
FirstName: FLORENCE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 30 W MONROE ST STE 1200
Address2:  
City: CHICAGO
State: IL
PostalCode: 606032420
CountryCode: US
TelephoneNumber: 3127339730
FaxNumber:  
Practice Location
Address1: 462 N TELEGRAPH RD
Address2:  
City: PONTIAC
State: MI
PostalCode: 483411037
CountryCode: US
TelephoneNumber: 2482347540
FaxNumber: 2485818716
Other Information
ProviderEnumerationDate: 08/05/2006
LastUpdateDate: 10/07/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/07/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X4301074204MIY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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