Healthcare Provider Details

I. General information

NPI: 1083045330
Provider Name (Legal Business Name): THOMASINE WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WATERMAN ST
DETROIT MI
48209-2022
US

IV. Provider business mailing address

1700 WATERMAN ST
DETROIT MI
48209-2022
US

V. Phone/Fax

Practice location:
  • Phone: 313-841-8900
  • Fax: 313-849-2702
Mailing address:
  • Phone: 313-841-8900
  • Fax: 313-840-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802063129
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: