Healthcare Provider Details

I. General information

NPI: 1346424447
Provider Name (Legal Business Name): THORREZ MEDICAL PRACTICE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 PACKARD RD SUITE 1
YPSILANTI MI
48197-2060
US

IV. Provider business mailing address

2900 PACKARD RD STE 1
YPSILANTI MI
48197-2061
US

V. Phone/Fax

Practice location:
  • Phone: 734-572-8686
  • Fax: 734-572-8866
Mailing address:
  • Phone: 734-572-8686
  • Fax: 734-572-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301035414
License Number StateMI

VIII. Authorized Official

Name: KATHLEEN M MCCARREN
Title or Position: OFFICE MANAGER
Credential:
Phone: 734-572-8686