Provider Demographics
NPI:1306994090
Name:THOMAS, MICHELLE (NP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:CAFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 430150
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48343-0150
Mailing Address - Country:US
Mailing Address - Phone:248-724-7700
Mailing Address - Fax:248-636-4025
Practice Address - Street 1:279 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3364
Practice Address - Country:US
Practice Address - Phone:248-724-7700
Practice Address - Fax:248-636-4025
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704130444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4726059Medicaid