MEDICARE: THOMAS WARD BISHOP PSY D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	P2573	TN
2	103TF0000X	Family Psychologist	6301017038	MI
3	103TC0700X	Clinical Psychologist	6301017038	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760480966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS WARD BISHOP PSY D

Provider Business Mailing Address
First Line	:	3621 SOUTH STATE STREET
Second Line	:	700 KMS PLACE
City	:	ANN ARBOR
State	:	MI
Zip	:	48108
Country	:	US
Telephone Number	:	734-936-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	14700 EAST OLD US 12
Second Line	:
City	:	CHELSEA
State	:	MI
Zip	:	48118-1185
Country	:	US
Telephone Number	:	734-475-1321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	06/09/2017

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