Healthcare Provider Details

I. General information

NPI: 1770604928
Provider Name (Legal Business Name): PREETI THABOLINGAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PREETI KALIA MD

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43750 WOODWARD STE 104
BLOOMFIELD HILLS MI
48302-5063
US

IV. Provider business mailing address

43750 WOODWARD STE 104
BLOOMFIELD HILLS MI
48302-5063
US

V. Phone/Fax

Practice location:
  • Phone: 248-334-6000
  • Fax: 248-334-8740
Mailing address:
  • Phone: 248-334-6000
  • Fax: 248-334-8740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number336078398
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: