Provider Demographics
NPI:1326020041
Name:THOMAS, MICHELE M (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
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 1:15838 FOUNTAIN PLAZA DR STE A
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7469
Mailing Address - Country:US
Mailing Address - Phone:636-484-5277
Mailing Address - Fax:
Practice Address - Street 1:15838 FOUNTAIN PLAZA DR STE A
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7469
Practice Address - Country:US
Practice Address - Phone:636-484-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108858207Q00000X
MO2005022502207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7177512OtherAETNA
IL$$$$$$$$$Medicaid
IL08221955OtherBLUE SHIELD
IL376020408401Medicaid
IL617915OtherHEALTHLINK
MO000000012859OtherESSENCE
MO000000013035OtherESSENCE COLUMBIA IL
MO1326020041Medicaid
IL202018OtherBCBS
IL265231OtherGHP
MOH45950OtherMERCY
IL0107929OtherUHC
IL202018OtherBCBS
MOP00282074Medicare PIN
MO1326020041Medicaid
IL$$$$$$$$$ 1Medicaid
MO147480028Medicare PIN