Healthcare Provider Details

I. General information

NPI: 1033783394
Provider Name (Legal Business Name): TOMMY HU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 07/16/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E HOSPITAL DR
ANN ARBOR MI
48109-4000
US

IV. Provider business mailing address

1522 SIMPSON DRIVE MPB D3230
ANN ARBOR MI
48109
US

V. Phone/Fax

Practice location:
  • Phone: 743-232-5933
  • Fax:
Mailing address:
  • Phone: 734-232-5933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301511721
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: