Provider Demographics
NPI:1184684656
Name:THOMAS, MINI (MD)
Entity type:Individual
Prefix:DR
First Name:MINI
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 1:6530 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7102
Mailing Address - Country:US
Mailing Address - Phone:954-729-7976
Mailing Address - Fax:
Practice Address - Street 1:5440 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-5005
Practice Address - Country:US
Practice Address - Phone:954-747-9897
Practice Address - Fax:954-747-9879
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI42290Medicare UPIN
FL29533ZMedicare ID - Type Unspecified