Healthcare Provider Details

I. General information

NPI: 1659559110
Provider Name (Legal Business Name): TECUMSEH FAMILY PRACTICE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E CUMMINS ST
TECUMSEH MI
49286-2070
US

IV. Provider business mailing address

501 E CUMMINS ST
TECUMSEH MI
49286-2070
US

V. Phone/Fax

Practice location:
  • Phone: 517-423-2960
  • Fax: 517-423-2786
Mailing address:
  • Phone: 517-423-2960
  • Fax: 517-423-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number008869
License Number StateMI

VIII. Authorized Official

Name: DR. DANIEL R DOMAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 517-423-2960