Healthcare Provider Details

I. General information

NPI: 1225031594
Provider Name (Legal Business Name): DONZA THOMAS WORDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33896 S TOWNLINE RD
DRUMMOND ISLAND MI
49726
US

IV. Provider business mailing address

PO BOX 506
PICKFORD MI
49774
US

V. Phone/Fax

Practice location:
  • Phone: 906-647-2217
  • Fax: 906-647-2228
Mailing address:
  • Phone: 906-647-2217
  • Fax: 906-647-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301057132
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: