Provider Demographics
NPI:1962503276
Name:THOMAS, ROSEMARIE (MD)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
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 1:9690 E MI STATE ROAD 36
Mailing Address - Street 2:PO BOX 606
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9703
Mailing Address - Country:US
Mailing Address - Phone:734-449-2033
Mailing Address - Fax:734-449-7186
Practice Address - Street 1:9690 E MI STATE ROAD 36
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-9703
Practice Address - Country:US
Practice Address - Phone:734-449-2033
Practice Address - Fax:734-449-7186
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3305428Medicaid
MI3305428Medicaid
MIG09873Medicare UPIN