Individual
EBONY I THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4375 NOTTINGHAM RD, DETROIT, MI 48224-3421
(586) 278-8706
Mailing address
4375 NOTTINGHAM RD, DETROIT, MI 48224-3421
(586) 278-8706
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
T520163343802
MI
Other
Enumeration date
10/28/2016
Last updated
03/19/2024
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