Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036120897 | IL |
N | 111NI0900X | Internist | 036120897 | IL |
Y | 207RG0100X | Gastroenterologist | 4301100025 | MI |
NPI | 1003083627 |
---|---|
Provider Name | Thomas Ryan Birris |
First Address | Saint Joseph, MI 49085-9149 |
Second Address | Saint Joseph, MI 49085-9149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2008 |
Last Update Date | 26/05/2021 |