Healthcare Provider Details

I. General information

NPI: 1710126156
Provider Name (Legal Business Name): THOMAS I KING DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 EAST TWELVE MILE RD BUILLDING C
MADISON HEIGHTS MI
48071
US

IV. Provider business mailing address

1431 EAST TWELVE MILE RD BUILLDING C
MADISON HEIGHTS MI
48071
US

V. Phone/Fax

Practice location:
  • Phone: 248-542-5374
  • Fax: 248-398-4345
Mailing address:
  • Phone: 248-542-5374
  • Fax: 248-398-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberTK001638
License Number StateMI

VIII. Authorized Official

Name: THOMAS I KING
Title or Position: PHYSICIAN
Credential: DPM
Phone: 248-542-7354