Provider Demographics
NPI:1225045537
Name:THOMAS, LORNA LACEN (MD)
Entity type:Individual
Prefix:DR
First Name:LORNA
Middle Name:LACEN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30445 NORTHWESTERN HWY
Mailing Address - Street 2:STE 142
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:313-874-2500
Mailing Address - Fax:248-702-0902
Practice Address - Street 1:30445 NORTHWESTERN HWY
Practice Address - Street 2:STE 142
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:313-874-2500
Practice Address - Fax:248-702-0902
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301404289207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1225045537OtherBLUE CROSS BLUE SHIELD
MI3173310 10Medicaid
MIFO1967Medicare UPIN
MI1225045537OtherBLUE CROSS BLUE SHIELD