Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 4301049422 | MI |
NPI | 1609829076 |
---|---|
Provider Name | Dr. Thomas James Trueheart |
First Address | Southfield, MI 48075-4917 |
Second Address | Southfield, MI 48075-4917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4628030 | (05) | MI |
F06147 | (02) | MI |