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Individual

LETACIA DENISE THOMAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
33155 ANNAPOLIS ST, WAYNE, MI 48184-2405
(313) 436-2577
Mailing address
16037 KNOLLWOOD DR, DEARBORN, MI 48120-1309
(404) 429-0432

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301097310
MI

Other

Enumeration date
07/13/2010
Last updated
07/13/2010
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