Individual
AMANDA A THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
48681 HAYES RD, SHELBY TWP, MI 48315-4403
(586) 799-1212
(586) 799-1210
Mailing address
15959 HALL RD, SUITE LL 104, MACOMB, MI 48044
(586) 799-1212
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005259
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
383120356
TAX IDENTIFICATION
MI
01
—
AT005259
LICENSE NUMBER
MI
Enumeration date
06/25/2008
Last updated
12/02/2015
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