NPI 1881904605

Thomas Park M.D. PC

Organisation Preferred Provider Organization Southfield, MI

Practice location

Address: 23077 Greenfield Rd Suite 257, Southfield, MI 48075-3709
Phone: (248) 552-0044
Fax: (248) 423-7777

Authorised official

Name: Thomas T Park
Title: President
Phone: (248) 552-0044

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 4301040933 (MI)

Other Preferred Provider Organization providers in Michigan →

Registry record

NPI: 1881904605
Entity type: Organization
NPI issued: 14 Oct 2010
Record last updated: 14 Oct 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.