Healthcare Provider Details

I. General information

NPI: 1518070317
Provider Name (Legal Business Name): TSEN S WOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36475 FIVE MILE RD ST MARY MERCY HOSPITAL
LIVONIA MI
48154
US

IV. Provider business mailing address

2200 LONG LAKE SHORES DR
W BLOOMFIELD MI
48323-1927
US

V. Phone/Fax

Practice location:
  • Phone: 734-655-4800
  • Fax: 734-655-1445
Mailing address:
  • Phone: 248-334-6594
  • Fax: 248-477-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number4301033148
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: