Healthcare Provider Details

I. General information

NPI: 1164669024
Provider Name (Legal Business Name): THOMAS JOSEPH RUANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26509 OLD HOMESTEAD CT
FARMINGTON HILLS MI
48331-3851
US

IV. Provider business mailing address

26509 OLD HOMESTEAD CT
FARMINGTON HILLS MI
48331-3851
US

V. Phone/Fax

Practice location:
  • Phone: 248-473-9462
  • Fax:
Mailing address:
  • Phone: 248-473-9462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301040828
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: