1053317479 NPI number — DR. THOMAS CARL HOSEY DPM

Table of content: (NPI 1669183711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053317479 NPI number — DR. THOMAS CARL HOSEY DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOSEY
Provider First Name:
THOMAS
Provider Middle Name:
CARL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053317479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42550 GARFIELD RD
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
CLINTON TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48038-1644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-263-4411
Provider Business Mailing Address Fax Number:
586-286-1142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42550 GARFIELD RD
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038-1644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-263-4411
Provider Business Practice Location Address Fax Number:
586-286-1142
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  5901001045 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: 5901001045 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103915 . This is a "GREATLAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DB8851 . This is a "RAILROAD GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5110230001 . This is a "ADMINASTAR FEDERAL DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 55010950 . This is a "BLUECROSS BLUESHIELD IND" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 135073500 . This is a "WORKER COMP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4618703 . This is a "MOLINA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00134504 . This is a "RAILROAD INDIVIDUAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: T34046 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4618703 . This is a "WELLNESS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200826048 . This is a "OMNICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4073108 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C2566 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 102168 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 009651 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 134618703 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480E015590 . This is a "BLUE CROSS BLUE SHIELD GP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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