Healthcare Provider Details

I. General information

NPI: 1558369025
Provider Name (Legal Business Name): THOMAS DAVID REDMOND D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 TURWILL LN
KALAMAZOO MI
49006-5225
US

IV. Provider business mailing address

333 TURWILL LN
KALAMAZOO MI
49006-5225
US

V. Phone/Fax

Practice location:
  • Phone: 269-373-1019
  • Fax: 269-373-1669
Mailing address:
  • Phone: 269-373-1019
  • Fax: 269-373-1669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901000730
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: