Healthcare Provider Details

I. General information

NPI: 1528358728
Provider Name (Legal Business Name): THOMAS J HERBST MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2011
Last Update Date: 04/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E WASHINGTON ST STE 708
ANN ARBOR MI
48104-2017
US

IV. Provider business mailing address

202 E WASHINGTON ST STE 708
ANN ARBOR MI
48104-2017
US

V. Phone/Fax

Practice location:
  • Phone: 734-327-9322
  • Fax:
Mailing address:
  • Phone: 734-327-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number4301057770
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number4301057770
License Number StateMI

VIII. Authorized Official

Name: DR. THOMAS J HERBST
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 734-327-9322